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Efficacy of Sacral Neuromodulation in the Majority Male and Elderly Veteran Population
OLAMIDE OLAWOYIN, MD, Harris E. Foster, MD.
Yale New Haven Health, NEW HAVEN, CT, USA.
Objective: To evaluate the efficacy of sacral neuromodulation (SNM) in Veterans Affairs (VA) Medical Center patients diagnosed with overactive bladder (OAB) with and without urge incontinence, and urinary retention.
Methods: We performed a retrospective cohort review of VA patients who underwent SNM device implantation between January 2017 and December 2024. Variables assessed included patient demographics, surgical indication, urodynamic evaluation, concurrent BPH diagnosis, programming compliance, and >50% symptom improvement at 6 months. Univariate analysis used two-tailed t-tests for continuous variables and Chi-square tests for categorical variables.
Results: Forty-five patients underwent SNM between 2017 and 2024. Mean age was 71 years; 82% were male and 87% were White. Urodynamic confirmation was obtained in 67% prior to implantation. Indications included OAB with urge incontinence (15/45), without urge incontinence (24/45), and urinary retention (6/45). Following Stage 1, 84% reported >50% symptom improvement and proceeded to Stage 2. Thirty-five percent had concurrent BPH. At 6 months, 50% reported continued improvement in frequency, urgency, and nocturia, with the most sustained results in OAB with urge incontinence (10/15 patients). No statistically significant differences in outcomes were found across demographics.
Conclusion: While 84% of VA patients advanced to Stage 2 implantation, only 51% maintained >50% improvement at 6 months, lower than the 85% reported in the general population, which skews younger and predominantly female. Despite this difference, SNM remains a feasible and effective treatment option for the predominantly elderly and male VA population, offering meaningful symptom relief for a group with limited alternatives.
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