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Bilateral Tined Lead Placement During Stage I Sacral Nerve Root Testing Significantly Improves Clinical Outcomes With Sacral Neuromodulation
David Gordon, Todd J Lehrfeld
University of Maryland, Baltimore, MD
Introduction: Success rates of sacral neuromodulation vary despite adequate sensory and motor responses during test stimulation. The effectiveness of a multiple staged two lead implant technique was explored to assess differences between leads before and after inital testing.
Method: 30 consecutive patients underwent placement of two sacral nerve (S3 or S4) stimulation leads in a staged fashion for refractory urinary frequency, urge incontinence, or idiopathic retention. All patients demonstrated adequate initial responses suggestive of potential therapeutic success for each lead during placement. A 7- 21 day period of testing was used for evaluating efficacy as judged by voiding diary and subjective improvement. Each lead was evaluated during the follow-up period in succession. A 50 % or greater improvement threshold was required for placement of a pulse generator and continuation of therapy.
Results: 92.5% of patients responded at one or both leads with greater than 50% improvement of symptoms, progressing to pulse generator implantation. There were no complications over single lead placement. Among the responders, 48% patients reported the opposite lead was more effective than the one initially chosen. Three patients could not tolerate one of the leads at follow-up. In the absence of a second test lead overall success would have been 44%-59%
Conclusion: There is a variable response to neuromodulation among candidate sacral nerve sites despite intraoperative screening parameters during initial lead placement. This observation may account for variation in therapeutic success among published reports. Placement of multiple test leads during staged implant enhances therapy success without added morbidity.
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