Technical and functional outcome after sacral neuromodulation using the "H" technique.

Abstract

Sacral neuromodulation (SNM) is awidely accepted treatment for pelvic floor disorders, including constipation and fecal incontinence (FI). In 2017, astandardized electrode placement method, the Htechnique, was introduced to minimize failure rates and improve clinical outcomes. We aimed to investigate the technical feasibility and functional outcome of the procedure. In this prospective study, we evaluated the first 50patients who underwent SNM according to the Htechnique between 2017 and 2020 at atertiary care hospital. Patient demographic and clinical data were collected, and the impact of various factors on patients' postoperative quality of life (QoL) was assessed after afollow-up of 40months. Functional outcome was monitored prospectively using astandardized questionnaire. Of 50patients, 36 (72%) reported greater than 50% symptom relief and received apermanent implant (95% CI: 58.3-82.5). We observed 75% success in relieving FI (95% CI: 58.9-86.3) and 64% in constipation (95% CI: 38.8-83.7). Complication occurred in five (10%) patients. Preoperative vs. postoperative physical and psychological QoL, Vaizey score, and obstructed defecation syndrome (ODS) scores revealed significant improvements (all p < 0.01). Male gender was significantly associated with postoperative complications (p = 0.035). We provide evidence for the technical feasibility and efficacy of the SNM implantation using the H technique. The medium-term results are promising for patients with FI and constipation. Male patients and those with aBMI > 25 are more prone to perioperative complications.