Sacral neuromodulation: standardized electrode placement technique: two-year outcomes, comparing the use of the straight versus curved stylet

Vaganee D1, Van de Borne S1, De Win G1, De Wachter S G1

Research Type

Clinical

Abstract Category

Neurourology

Abstract 508
Open Discussion ePosters
Scientific Open Discussion Session 28
Friday 31st August 2018
12:45 - 12:50 (ePoster Station 2)
Exhibition Hall
Neuromodulation Pelvic Floor Surgery Prospective Study
1. Department of Urology, Antwerp University Hospital, Edegem, Belgium
Presenter
D

Donald Vaganee

Links

Poster

Abstract

Hypothesis / aims of study
Sacral neuromodulation (SNM) is an established second-line therapy for functional disorders of the pelvic organs. Recently, a standardized electrode placement technique was described.
This study presents the follow-up data over 24 months using the standardized electrode placement technique, comparing the use of a curved versus straight stylet.
Study design, materials and methods
Single tertiary center, prospective study (August 2013 - June 2015) involving 40 patients with overactive bladder dry (OABD) and wet (OABW) and 15 with non-obstructive urinary retention (NOUR) refractory to first-line treatment. Primary outcome: successful tined lead procedure and intention to treat analysis at 12 and 24 months. Success was defined by >50% reduction in relevant parameters noted on a 3-days voiding diary and patient satisfaction.
Results
Gender: 42 females (76%); 13 males (24%). Age: 51.7 +/- 17.0 years (range 18-79 years). Indications: OABD: 6 (11%); OABW: 34 (62%); NOUR 15 (27%). Baseline voiding parameters: OABD: 16.5 +/- 3.6 voids/24h; OABW: 4.4 +/- 2.7 urgency incontinence episodes/24h; NOUR: 3-5x self-catheterizations/24h.

33/35 (94%) patients implanted with the curved lead had a successful tined lead procedure versus 13/20 (65%) implanted with the straight lead (Chi²; p=0.005). Intention to treat analysis at 12 and 24 months were respectively 94% and 91% for the curved lead compared to 65% and 45% for the straight group (Chi²; p=0,002 and p<0.001).
Interpretation of results
The intention to treat (ITT) results of the straight lead placements are in line with the results reported by large trials. The ITT results of the curved lead placements are clearly higher. As the patient characteristics of this study are in line with those previously reported we believe this is related to the standardized implant technique and the curved design of the lead, making small adjustments in lead placement possible.
Concluding message
SNM using the standardized electrode placement technique is an efficacious treatment for OABD, OABW and NOUR. Furtherrmore, the use of a curved stylet leads to more successful tined lead procedures and better success rates after 12 and 24 months follow-up when compared to use of the straight stylet.
Figure 1
References
  1. van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. The Journal of urology 2007;178(5):2029-34 doi: 10.1016/j.juro.2007.07.032.
  2. Siegel S, Noblett K, Mangel J, et al. Five-Year Followup Results of a Prospective, Multicenter Study of Patients with Overactive Bladder Treated with Sacral Neuromodulation. The Journal of urology 2018;199(1):229-36 doi: 10.1016/j.juro.2017.07.010.
  3. Amundsen CL, Komesu YM, Chermansky C, et al. Two-Year Outcomes of Sacral Neuromodulation Versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: A Randomized Trial. Eur Urol 2018 doi: 10.1016/j.eururo.2018.02.011.
Disclosures
Funding None Clinical Trial Yes Public Registry No RCT Yes Subjects Human Ethics Committee Committee for Medical Ethics UZA-UAntwerp Helsinki Yes Informed Consent Yes
28/03/2024 07:01:11