Hypothesis / aims of study
Sacral neuromodulation (SNM) is part of the therapeutic arsenal used in the management of refractory overactive bladder, fecal incontinence, and pelvic pain. The procedure is usually performed in two stages: placement of an electrode at the third sacral nerve root, followed by implantation of the pulse generator if clinical improvement is observed during the test phase. The primary objective of this study was to analyze, at two years, the rate of definitive generator implantation, as well as device removal and replacement rates.
Study design, materials and methods
We extracted from the French national hospital discharge database (PMSI) all hospitalization codes corresponding to the implantation of a test electrode for SNM between 2018 and 2022 in patients older than 18 years. Patients who underwent concomitant generator implantation during the same hospital stay were excluded. Diagnoses identified through associated ICD-10 codes were used to classify patients according to indications. We assessed codes for definitive generator implantation within two months following the test phase, as well as generator removals and reimplantations during subsequent hospitalizations at 3, 6, 9, 12, 18, and 24 months after definitive implantation.
Results
Since 2016, coding related to SNM has shown an overall increase, despite a temporary decline associated with the COVID-19 pandemic. Between 2018 and 2022, 5,656 test electrodes were implanted. A total of 2,722 patients were included in the analysis. Indications were urological in 64% of cases, gastrointestinal in 13.7%, pain-related in 1.7%, and urinary retention in 4.1%. Patients with urological indications had a definitive implantation rate of 63.4%, higher than that observed in other groups; three-quarters were women, who demonstrated better implantation rates. Patients older than 80 years had lower implantation rates compared to other age groups. At two years, among the 2,722 definitive implantations, device removal occurred in 8.8% of patients and device replacement in 24.2%.
Interpretation of results
This study provides an estimate close to real-world practice regarding the evolution and use of SNM in France. However, limitations related to the use of PMSI data restrict detailed analysis.