Sacral neuromodulation (SNS) is approved by the Food and Drug Administration as a third-line treatment for refractory overactive bladder, idiopathic urinary retention, and fecal incontinence. Prior to implantation of an implantable pulse generator, all patients undergo a trial phase to ensure symptom improvement. The published success rates of progression from the test phase to permanent implant vary widely (range, 24% to >90%). We sought to characterize success rates using a statewide registry.
Using nonpublic data, we identified SNS procedures using the California Office of Statewide Planning and Development ambulatory surgery database from 2005 to 2011. A successful trial was defined as receiving a stage 2 generator implantation after trial lead placement. Multivariable logistic regression was performed to identify factors associated with staged success.
During the study period, 1396 patients underwent a staged SNS procedure, with 962 (69%) subsequently undergoing generator placement. Successful trial rates were 72% for overactive bladder wet, 69% for urgency/frequency, 68% for interstitial cystitis, 67% for neurogenic bladder, and 57% for urinary retention. On multivariate logistic regression, only male sex (odds ratio, 0.51) and urinary retention [odds ratio, 0.54) were significantly associated with lower odds of success, whereas age, race/ethnicity, medical insurance, and placement at an academic or high-volume institution had no association.
The “real world” success rates for staged SNS implantation in California are less than those observed by some academic centers of excellence but better than previously reported for Medicare beneficiaries. Successful trial rates for interstitial cystitis and neurogenic voiding dysfunction are similar to refractory overactive bladder.
From the *Department of Urology, Stanford University School of Medicine, Stanford, CA;
†University of Central Florida College of Medicine, Orlando, FL; and
‡Division of Urology, Valley Specialties Clinic, Santa Clara Valley Medical Center, San Jose, CA.
Correspondence: Christopher S. Elliott, MD, PhD, Division of Urology, Valley Specialties Clinic, Santa Clara Valley Medical Center, 751 S Bascom Ave, San Jose, CA 95128. E-mail: email@example.com.
Funding for this project was provided by the Valley Medical Care Foundation. A.D.D. receives salary support from the KL2 component of the Stanford Clinical and Translational Science Award to Spectrum (NIH KL2 TR 001083).
A.D.D. (principal investigator) is supported by SUFU Foundation Study of Chemodenervation funded by the Allergan Foundation. The other authors have declared they have no conflicts of interest.