Poster, Podium & Video Sessions
Presentation Authors: serge Marinkovic*, Joseph Ford, Detroit, MI
Introduction: Will attainment of 3-volts motor provocation [MP] during Stage 1 sacral neuromodulation [SNM] tine lead placement result in a better clinical outcome with overactive bladder symptoms [OBS] or urinary retention [UR] symptoms in women?
Methods: We conducted an observational, retrospective quadruple cohort review of 339 female patients who between January 2002 and January 2014 underwent Stage 1 and Stage 2 SNM; Group A [174 women with MP 3-volts], Group B [110 women with MP ≥4-volts] both with medically recalcitrant overactive bladder symptoms, Group C [33 women with MP 3-volts], Group D [22 women MP ≥4- volts] both the latter with non-obstructive urinary retention. Success rate was defined as a ≥50% improvement in voiding parameters, Urinary Distress Inventory-6 [UDI-6], Incontinence Impact Questionnaire-7 [IIQ-7] and a PVR <100 mls. All study participants were fully ambulatory, with an anesthetic risk score of 3 or less [range 0-5], and had no neurological disease or had received chemotherapy/ radiation therapy. All four cohorts did not differ in clinical and demographic information. Patients had pre-and post-operative values obtained from 72-hour voiding diaries for frequency, urgency, urgency incontinence, nocturia, reprogramming sessions, post-void residual urine, Likert scores, UDI-6 and IIQ-7 scores.
Results: Mean follow-up in months were Group A, 116.3±30.3 and Group B, 112±34.6 [p<0.354], Group C, 150.5±20.4 and Group D, 145.8±17.2 [p<0.38]. Patients with one or leads at 3-volts performed statistically better with improvements to Stage 1 to Stage 2 Conversion Rate-Group A, 93.5 % versus Group B, 72.3% [p<0.001] and Group C, 94% versus Group D, 70% [p<0.001]. Success rate at follow-up. Group A, 82.1% versus Group B, 63% [p<0.001], Group C, 85% versus Group D 72.9% [p=0.32, too small sample for significance]. Most voiding parameters, Likert and UDI-6, IIQ-7 scores and reduced reprogramming sessions were statistically significantly improved for Group’s A and C versus Group B and D with a range of p<0.02 to p<0.001. Amongst Group A and C the attainment of multiple leads at 3, 2, or 1 volts imparted no statistically significant improvement regarding all voiding parameters.
Conclusions: Our straight-forward surgical technical modification to motor provocation at 3 volts may impart a statistically significant improvement in the long-term to most voiding, Likert, UDI-6 and IIQ-7 scoring parameters for both OBS and UR. Controlled trials should be recommended to confirm our results.
Source Of Funding: None
Thursday, May 11
6:42 PM – 6:48 PM
Saturday, May 13
9:30 AM – 11:30 AM