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Predictive Factors For Patient Satisfaction With Sacral Neuromodulation In Chronic Voiding Dysfunction
Michelle L Ramirez, Michelle L Persun, Phillip C Ginsberg, Richard C Harkaway
Albert Einstein Medical Center, Philadelphia, PA
Introduction: Sacral neuromodulation is an FDA-approved treatment for a variety of voiding dysfunctions that are refractory to conservative treatment. Studies have shown success rates of up to 80%; however, more than 20% of patients who undergo a successful test stimulation period, defined by at least 50% improvement in symptoms, fail to respond. We sought to identify other predictive factors for successful treatment of lower urinary tract symptoms with InterStim® neuromodulation.
Materials & Methods: We retrospectively analyzed 51 patients with chronic, nonobstructive frequency and urgency refractory to medical therapy who were treated with staged placement of the InterStim® device. Two cohorts were identified: those who were satisfied with treatment and those who were not according to a subjective grading scale. Variables were analyzed using paired t-tests.
Results: Of the 51 patients evaluated, 3 patients were excluded secondary to infection. Of the 48 remaining patients, 77% were female. Thirty-nine patients (81%) were satisfied with their improvement in symptoms, while 9 patients (19%) were dissatisfied. Age, sex, weight, the number of anticholinergic medications previously used, and the number of prior urologists sought in treatment were comparable between the two groups (p>0.05). Approximately 18% of patients in satisfied group were using chronic narcotic medication for pelvic pain control compared to 67% in the dissatisfied group (p=0.002).
Conclusions: Sacral neuromodulation is a successful means of treatment for refractory chronic voiding dysfunction. Regardless of undergoing staged placement after a successful stimulation trial, those who use chronic narcotics are less likely to be satisfied with Interstim® therapy.
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