A Five-Year Retrospective Study on the Clinical Outcomes of Sacral Nerve Stimulation for Neuromodulation of the Lower Urinary Tract in a Tertiary Hospital.

AIM

To assess clinical outcomes in terms of first to second-stage conversion rates, revision rates, and complications for all patients undergoing sacral neuromodulation of the lower urinary tract for the past five years at the Queen Elizabeth Hospital Birmingham.

METHOD

This is a retrospective observational study. Only patients with the first stage of sacral neuromodulation between January 2017 and January 2023 were included in the study. The data collected included age, type of first-stage trial, that is, percutaneous nerve evaluation (PNE) vs. tined lead, response after the first stage, whether a second trial was carried out, response after the second trial, indication for sacral nerve stimulation (SNS), complications, revisions, etc. Results: 94% of the total (198) patients had PNE at the first trial, while 11 (6%) had tined lead. 129 (65%) patients had a positive response after the first trial, 49 (24%) had a negative response, and 20 (10%) had an equivocal response. 15 (8%) patients from the equivocal and negative response group had a second trial with a tined lead, with 53.3% (104) receiving a positive response, making our total conversion rate 69% (136). 100 (50%) patients had permanent implants fitted, 25 (13%) had complications, and 15 (7.5%) required revision. The indications for the revisions were lead migration (66, 33.33%), pain around the battery site (66, 33.33%), connection failure (40, 20%), battery charging problem (13, 6.67%), and device infection (13, 6.67%).

CONCLUSION

The conversion and complication rates are comparable to national standards and documentation in the literature, while the infection rates were lower. Higher conversion rates may be attained when tined lead is used at the first trial.