MP89-01 PUDENDAL NEUROMODULATION AFTER FAILED SACRAL STIMULATION

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-Neurogenic Voiding Dysfunction1 Apr 2015MP89-01 PUDENDAL NEUROMODULATION AFTER FAILED SACRAL STIMULATION Kenneth M. Peters, Kim A. Killinger, Michael Ehlert, Priyanka Gupta, Jamie Bartley, Cheryl Wolfert, Judith A. Boura, and Jason Gilleran Kenneth M. PetersKenneth M. Peters More articles by this author , Kim A. KillingerKim A. Killinger More articles by this author , Michael EhlertMichael Ehlert More articles by this author , Priyanka GuptaPriyanka Gupta More articles by this author , Jamie BartleyJamie Bartley More articles by this author , Cheryl WolfertCheryl Wolfert More articles by this author , Judith A. BouraJudith A. Boura More articles by this author , and Jason GilleranJason Gilleran More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1800AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many patients benefit from sacral neuromodulation (SNM) yet some do not achieve significant clinical improvements. Patients that fail SNM may benefit from increased afferent stimulation via tined lead placement at the pudendal nerve. We evaluated 2-year outcomes in patients that had a pudendal lead placed after failed sacral neuromodulation (SNM). METHODS Adults enrolled in our prospective observational neuromodulation study that had a pudendal lead placed were evaluated. Medical records were reviewed. Outcomes were measured at 3, 6, 12 and 24 months with Interstitial Cystitis Symptom/Problem Indices (ICSI-PI), Overactive Bladder Questionnaire (OABq) symptom and quality of life (QOL) domains, voiding diaries, and Global Response Assessments (GRA). Data were examined with Pearson's Chi-square, Fisher's Exact, and Wilcoxon rank sum tests. RESULTS Of 103 patients that had a pudendal lead placed, 48 (46.6%) had prior SNM (mean age 54 ± 18 years; 85% female). Primary urologic diagnoses were urinary urgency/frequency with urge incontinence (18/48; 37.5%), interstitial cystitis/bladder pain syndrome (11/48; 22.9%), urgency/frequency (8/48: 16.7%), urinary retention (8/48; 16.7%), and pelvic pain (3/48; 6.3%). Mean operative time for lead placement was 48 ± 19 minutes and 45/48 (93.8%) underwent generator implantation. Overall, 11 patients required 12 reoperations after lead implant; 5 of these occurred within the first 2 years. 4 were explanted at median 42 months (25th, 75th: 21.9, 50.9 months). 10/11 patients had symptom worsening as a reason for reoperation. Lead migration was identified in 2 patients. On average, 45% (range 31 to 50%) of survey responders that had prior SNM reported moderate or marked improvement in urgency, frequency, and urge incontinence at 3, 6, 12, and 24 months on the GRA. Significant improvements were seen over 2 years in ICSI−PI composite score (p<0.0001), OABq symptom severity (p<0.0001), and QOL improved (p<0.0001). When compared to pudendal patients that had not had prior SNM, urologic diagnoses, operative time, generator implant rate, reoperations, lead migration, and GRA responses were similar; ICSI-PI and OABq scores also improved significantly over time (p<0.0001 and p<0.0001 respectively). CONCLUSIONS Pudendal neuromodulation is a reasonable alternative for patients regardless of prior sacral failure. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1100 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth M. Peters More articles by this author Kim A. Killinger More articles by this author Michael Ehlert More articles by this author Priyanka Gupta More articles by this author Jamie Bartley More articles by this author Cheryl Wolfert More articles by this author Judith A. Boura More articles by this author Jason Gilleran More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...