The aim of this study was to optimize sacral neuromodulation (SNM) therapy by evaluating the clinical outcomes of the variable-frequency (VF) mode and to explore the suitability of this mode for different patient populations with lower urinary tract symptoms (LUTS).

A prospective clinical trial was conducted involving 55 patients with LUTS, who were randomized to receive either constant frequency (CF) or VF SNM treatment over a 12-week period. The efficacy of both modes was assessed using a comprehensive set of indicators, including Quality of Life (QoL), Visual Analogue Scale (VAS), and Overactive Bladder Symptom Score (OABSS). Logistic regression analysis was employed to identify patient characteristics that are predictive of better outcomes with the VF mode. A nomogram web tool was developed to assist clinicians in selecting the most appropriate SNM frequency mode for individual patients.

The VF mode showed superior improvement rates across most monitored parameters compared to the CF mode. However, logistic regression revealed counterintuitive findings: patients with higher BMI, more comorbidities, more LUTS-related symptoms, or a diagnosis of Neurogenic Lower Urinary Tract Dysfunction (NLUTD) were less likely to benefit from the VF mode. The developed nomogram web tool demonstrated good discriminative ability with an area under the receiver operating characteristic curve (AUC) of 0.833 for both training and validation groups.

Research indicates that for LUTD patients, VF SNM offers higher clinical benefits without increased risks compared to constant frequency. Patients with milder symptoms, no neurogenic LUTD, lower OABSS, or lower BMI benefit more from VF. The nomogram web tool aids clinical decision-making, promoting precision medicine in LUTD treatment. Further research is needed to understand patient responses to different SNM frequencies.

The study provides evidence that while VF SNM may offer enhanced clinical benefits, its effectiveness varies among patient populations. The identification of patient characteristics associated with treatment outcomes is crucial for the personalized application of SNM therapy. The nomogram web tool facilitates the clinical decision-making process, promoting precision medicine in LUTS treatment. Further research is needed to better understand the mechanisms underlying the observed patient responses to different SNM frequency modes.