Institutional members access full text with Ovid®

Share this article on:

Reoperation After Sacral Neuromodulation Therapy: A Single-Institution Experience

Shih, Cheryl MD*; Miller, Jane L. MD*; Fialkow, Michael MD, MPH; Vicars, Brenda G. RN*; Yang, Claire C. MD*

Female Pelvic Medicine & Reconstructive Surgery: May/June 2013 - Volume 19 - Issue 3 - p 175–178
doi: 10.1097/SPV.0b013e31828ab3c9
Original Articles

Objectives Sacral neuromodulation has become an accepted treatment for various types of lower urinary tract dysfunction. However, despite technologic advances in device implantation and a trial stimulation period, sacral neuromodulation still has a significant reoperation rate. We report our single-institution experience of reoperation rates.

Methods We performed a retrospective review of our patients who had undergone the implantation of the InterStim device from April 1999 to December 2011 for lower urinary tract dysfunction.

Results A total of 155 InterStim devices were implanted by 2 surgeons. Of the 142 patients with complete follow-up, 55 (38.2%) patients required reoperation, for either revision or explantation of the device. Revisions were performed in 30 (21.1%) patients, most commonly for mechanical failure of device, battery end-of-service, and pain, either at the site of the implanted pulse generator or with stimulation. Of the 30 patients who underwent revision, 14 had successful results, 6 had persistent symptoms, and 10 progressed to eventual explantation.

The overall explantation rate was 24.6% (35 of 142 patients), and the average time to removal was 44 months. Most of the explantations were performed for poor symptom control and failure to maintain response (74.3%).

Reoperation was not associated with age, sex, obesity, diabetes, chronic pain, use of the tined lead, or type of lower urinary tract dysfunction.

Conclusions Sacral neuromodulation has a substantial revision and explantation rate, without any clear predictors for these complications. Patients should be counseled to these complications before surgery.

From the Departments of *Urology and †Obstetrics and Gynecology, University of Washington, Seattle, WA.

Reprints: Cheryl Shih, MD, Department of Urology, University of Washington School of Medicine, 1959 NE Pacific St, Box 356510, Seattle, WA 98195. E-mail: csshih@uw.edu

The authors have declared they have no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins