Sacral Neuromodulator Surgery: Is There an Ideal Candidate?

TL;DR

This study evaluates sacral neuromodulator surgery for bladder conditions, finding it effective but with limited predictive factors for success.

Contribution

The study identifies that patient demographics and intraoperative parameters poorly predict SNM success, suggesting a need for better selection criteria.

Findings

SNM significantly reduced catheterization and pad use in both OAB and UAB patients.

Most SNM removals occurred after the first stage due to lack of efficacy.

Patient satisfaction was high among those with permanent implants.

Abstract

Objectives

Sacral neuromodulator implantation (SNM) is an advanced line of treatment for patients with overactive bladder (OAB) or underactive bladder (UAB). The procedure has two steps; patients who respond to temporary SNM proceed to permanent implantation. In this study, we aimed to evaluate the overall effectiveness of SNM in our patient population, as well as to identify potential correlations between patient demographics, clinical characteristics, and procedural outcomes. Additionally, we examined factors that may influence patient-reported satisfaction following SNM implantation.

Methods

A retrospective analysis was performed at the Department of Urology, Rambam Health Care Campus, Haifa, Israel, on individuals who underwent sacral neuromodulation between 2019 and 2024. Data collected included patient demographics, intraoperative variables, and procedural success rates. Baseline symptoms were compared to post-implantation symptoms in the OAB and UAB groups.

Results

A total of 47 patients underwent SNM implantation - 39 (83%) with UAB and eight (17%) with OAB. Of these, 79% proceeded to permanent SNM (implantation rate), and 68% retained the permanent device (success rate). Among the 25 with permanent SNM, 22 (88%) were satisfied, with an average reported satisfaction of 71%. In the UAB group, catheterizations decreased from four to two per day and pad use from six to two per day. In the OAB group, urinary frequency dropped from 16 to nine, nocturia from four to two, and pad use from 11 to three per day. No patient characteristics predicted success. Complications (local pain/infection) led to SNM removal in four (9%) patients.

Conclusions

SNM appears to be an effective treatment for both OAB and UAB patients, with significant reductions in catheterization and pad use, significant improvements in quality of life, and high self-reported satisfaction rates. Most removals occurred after the first stage, primarily due to lack of efficacy. Our findings suggest that intraoperative parameters and patient demographics have limited predictive value for success, emphasizing the need for improved selection criteria and individualized patient counseling prior to implantation, in order to optimize outcomes and minimize unnecessary procedures.