Hornung Christopher M, Vasdev Ranveer, Hanson Kate A, Gotlieb Rachael, Fok Cynthia S, Fischer John, Nakib Nissrine A, Nelson Dwight E
Department of Urology, University of Minnesota School of Medicine, Minneapolis, MN, USA.
Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.
Int Neurourol J. 2022 Sep;26(3):227-233. doi: 10.5213/inj.2244084.042. Epub 2022 Sep 30.
We quantified patient record documentation of sacral neuromodulation (SNM) threshold testing and programming parameters at our institution to identify opportunities to improve therapy outcomes and future SNM technologies.
A retrospective review was conducted using 127 records from 40 SNM patients. Records were screened for SNM documentation including qualitative and quantitative data. The qualitative covered indirect references to threshold testing and the quantitative included efficacy descriptions and device programming used by the patient. Findings were categorized by visit type: percutaneous nerve evaluation (PNE), stage 1 (S1), permanent lead implantation, stage 2 (S2) permanent impulse generator implantation, device-related follow-up, or surgical removal.
Documentation of threshold testing was more complete during initial implant visits (PNE and S1), less complete for S2 visits, and infrequent for follow-up clinical visits. Surgical motor thresholds were most often referred to using only qualitative comments such as "good response" (88%, 100% for PNE, S1) and less commonly included quantitative values (68%, 84%), locations of response (84%, 83%) or specific contacts used for testing (0%). S2 motor thresholds were less well documented with qualitative, quantitative, and anatomical location outcomes at 70%, 48%, and 36% respectively. Surgical notes did not include specific stimulation parameters or contacts used for tests. Postoperative sensory tests were often only qualitative (80%, 67% for PNE, S1) with quantitative values documented much less frequently (39%, 9%) and typically lacked sensory locations or electrode-specific results. For follow-up visits, <10% included quantitative sensory test outcomes. Few records (<7%) included device program settings recommended for therapy delivery and none included therapy-use logs.
While evidence suggests contact and parameter-specific programming can improve SNM therapy outcomes, there is a major gap in the documentation of this data. More detailed testing and documentation could improve therapeutic options for parameter titration and provide design inputs for future technologies.
我们对本机构骶神经调节（SNM）阈值测试和编程参数的患者记录文档进行了量化，以确定改善治疗效果和未来SNM技术的机会。
对40例SNM患者的127份记录进行回顾性研究。筛查记录中的SNM文档，包括定性和定量数据。定性内容涵盖对阈值测试的间接提及，定量内容包括疗效描述和患者使用的设备编程。研究结果按就诊类型分类：经皮神经评估（PNE）、第一阶段（S1）、永久电极植入、第二阶段（S2）永久脉冲发生器植入、与设备相关的随访或手术取出。
阈值测试的文档在初次植入就诊（PNE和S1）期间更完整，在S2就诊时较不完整，在随访临床就诊时则很少见。手术运动阈值最常仅使用定性评论提及，如“良好反应”（PNE、S1分别为88%、100%），较少包含定量值（68%、84%）、反应位置（84%、83%）或用于测试的特定触点（0%）。S2运动阈值在定性、定量和解剖位置结果方面的记录较少，分别为70%、48%和36%。手术记录未包括用于测试的特定刺激参数或触点。术后感觉测试通常仅为定性（PNE、S1分别为80%、67%），定量值记录频率低得多（39%、9%），且通常缺乏感觉位置或电极特定结果。对于随访就诊，<10%包括定量感觉测试结果。很少有记录（<7%）包括推荐用于治疗的设备程序设置，且没有记录包括治疗使用日志。
虽然有证据表明特定触点和参数的编程可改善SNM治疗效果，但该数据的文档记录存在重大差距。更详细的测试和文档记录可改善参数滴定的治疗选择，并为未来技术提供设计输入。
