Subcutaneous tunneling of the temporary testing electrode significantly improves the success rate of subchronic sacral nerve modulation (SNM)

Abstract

Sacral nerve modulation (SNM) is an effective way to treat non-neurogenic dysfunctions of pelvic organs. For over 20 years, this technique has been used for the treatment of overactive bladder, urinary retention, pelvic pain and even more recently, fecal incontinence and constipation. The objective of the study is to improve the fixation of the temporary testing electrode (TTE) in order to obtain more reliable results in the testing phase which should lead to have a comparable success rate as the two-stage implant for a chronic implant. Twenty-eight patients (ratio of sex women:men = 3:1; with overactive bladder, urinary retention, pelvic pain syndrome and fecal incontinence) were evaluated by the modified temporary test electrode (TTE) placement. With the subcutaneous tunneling technique (mean time of evaluation 8.3 days), it is possible to perform percutaneous nerve evaluation (PNE) more effectively with an objective, reliable and less expensive outcome prior to the implantation of the implantable sacral nerve stimulator in almost 80% of the evaluated patients. Because the costs of therapy are not covered by health insurance in all countries, there is a need for an effective and inexpensive way to test and select patients appropriately. The tunneled TTE maintains its place for consistent amplitude during the entire test duration. The modification of placing the TTE produces repayable results. This technique can be performed on an outpatient basis to evaluate sacral nerve modulation as an early treatment option for non-dysfunctions of pelvic organs before they are forwarded to a specialized center for a chronic SNM implantation.