MP30-01 “MIXED” MOTOR SACRAL NEUROMODULATION LEAD PLACEMENT RESULTS IN HIGHER IMPLANT RATES

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You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (MP30)1 Apr 2020MP30-01 “MIXED” MOTOR SACRAL NEUROMODULATION LEAD PLACEMENT RESULTS IN HIGHER IMPLANT RATES Kristen Gurtner, Anastasia Couvaras*, and Colin Goudelocke Kristen GurtnerKristen Gurtner More articles by this author , Anastasia Couvaras*Anastasia Couvaras* More articles by this author , and Colin GoudelockeColin Goudelocke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000869.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Motor response is recognized as an important guide to sacral neuromodulation (SNM) lead placement as many leads are placed under sedation that alters sensory response. While there is scarce data on optimal characteristics of placement, several publications have explored ideal location, number of electrodes eliciting a response, amplitude of motor threshold and type of motor response associated with successful implantation. Optimized leads have been considered to: provoke response at low amplitudes, utilize all electrodes and prompt a bellows before a toe response. Emerging data may affect what is considered an optimized lead. METHODS: This represents an analysis of a prospective database examining the relationships among motor threshold characteristics, patient reports of sensation and the success and durability of SNM therapy. Leads were placed between November 2017 and August 2019 by a single surgeon with high-volume SNM experience. The amplitude of both toe and bellow motor threshold was recorded for each electrode. This analysis includes patients undergoing staged lead testing for urgency symptoms and voiding dysfunction including non-obstructive urinary retention. Patients having simultaneous pulse generator and lead placement or those undergoing lead revision were excluded. Leads were classified as ″bellows″ or ″toe″ when the lowest motor threshold on all four electrodes was uniform while ″mixed″ leads showed equal or alternating amplitudes across the lead. All leads demonstrated motor response on 4 electrodes. RESULTS: A total of 102 staged leads were placed with 82/102 (80‰) of patients implanted. Distribution of leads were: bellows (22/102; 22‰), toe (8/102; 8‰) and mixed (72/102; 70‰). Implantation rate for mixed leads was 88‰ (63/72) but only 68‰ (15/22; p<0.03) for bellows. Toe-dominant leads were implanted at 50‰ (4/8; p<0.006). Analysis suggests that distal electrode response may be paramount as leads with distal electrodes having equal bellow and toe thresholds had an implant rate of 100‰ (17/17) vs 72‰(31/43; p<0.02) for those with bellows lowest. No differences were seen with proximal electrodes. CONCLUSIONS: While bellows response has traditionally been sought as the ″first″ motor response for SNM lead implantation, our data suggest that a mixed pattern of response appears to result in higher rates of implantation. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e438-e438 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristen Gurtner More articles by this author Anastasia Couvaras* More articles by this author Colin Goudelocke More articles by this author Expand All Advertisement PDF downloadLoading ...