Study design, materials and methods
This retrospective cohort study included patients undergoing PNE, comparing fluoroscopic-guided and landmark-guided techniques. The primary outcome was defined as symptom improvement leading to a full SNM implant. We performed univariate and multivariate logistic regression analyses to assess the impact of PNE technique, adjusting for demographic characteristics, the surgeon, and clinical indication. Subgroup analysis was conducted for patients with overactive bladder (OAB): urgency urinary incontinence (UUI) (239 patients) and OAB dry (64 patients).
Results
We recruited 362 patients with mean age 64.6 (±14.9). The most common indication was UUI followed by urgency frequency syndrome (OAB dry). The fluoroscopy group (n=208) had a higher proportion of female patients compared to the landmark guided group (n=154) (89.4% vs. 79.2%, p = 0.01). Indications for PNE differed between groups, with UUI and non-obstructive urinary retention (NOUR) more common in the fluoroscopy group, while fecal incontinence was more prevalent in the landmark guided group (p<0.001). The analysis showed no significant difference in PNE success between the two implantation techniques (p=0.81). This lack of difference was consistent in the subgroup of patients with OAB, with no significant variation in success for UUI (p=0.49) and OAB dry (p=0.08) between the implantation techniques. Overall, the only factor associated with success rates was the indication for PNE. Patients with NOUR and dual urinary and fecal incontinence were less likely to proceed to full implant compared to those with UUI alone (NOUR OR 0.16, p = 0.001; dual incontinence OR 0.07, p = 0.022), regardless of the implantation technique.
Interpretation of results
Fluoroscopy and landmark-guided techniques for PNE demonstrated no difference in procedural success, as defined by progression to full SNM implant