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Comparing Differences in Sacral Neuromodulation Device Management in Patients with Neurogenic Lower Urinary Tract Dysfunction versus Non-Neurogenic Conditions
Architha Sudhakar, MD1, Emma Harwood, MD1, Madeleine Powers, BS2, Evelyn James, MPH1, Sanchita Bose, MD1.
1Maine Medical Center, Portland, ME, USA, 2University of New England Osteopathic College of Medicine, Biddeford, ME, USA.
BACKGROUND: Neurogenic lower urinary tract dysfunction (NLUTD) is an increasingly prevalent condition in the United States. Although sacral neuromodulation (SNM) is not FDA-approved for this condition, it has been explored off-label as a management strategy. There is limited data investigating outcomes of SNM in the NLUTD cohort compared to patients with non-neurogenic urinary dysfunction. This is a novel retrospective study characterizing differences in device programming and other adjustments following initial implantation between these cohorts.
METHODS: All adult patients who underwent initial full stage SNM implantation from 2020-2025 with a single surgeon at a tertiary care center were included. We conducted retrospective chart review to determine general demographics, age at initial implant, presence of diagnosis pertaining to NLUTD, number of post-operative device programming changes, and need for revisions/replacements. Patients were characterized as “NLUTD” if they had an appropriate diagnosis and “non-neurogenic” if without. We compared differences across both cohorts using Fisher's exact test for categorical data and Wilcoxon ranked sum for continuous data.
RESULTS: Of 127 total patients, 30 underwent full stage implantation for NLUTD while 97 were non-neurogenic. While there were no differences in number of device programming changes between the cohorts, the rate of revision/replacement was increased in the NLUTD group compared to non-neurogenic (40.7% vs 15.9%, p<0.01). Notably, patients in the NLUTD group underwent implantation at a younger age (66 vs 72 years, p=0.01). The NLUTD group also appeared to have increased utilization of custom program settings, however this was not statistically significant.
Table 1.
| | | NLUTD
(N=30) | | Non-neurogenic
(N=97) | | Total
(N=127) | | P - Value |
| Number of device programming changes following initial implantation | | | | | | | | 0.1 |
| Median [Q1 - Q3] | | 2.00 [1.00 - 3.00] | | 1.00 [1.00 - 3.00] | | 2.00 [1.00 - 3.00] | | |
| Mean [SD] | | 2.32 [1.32] | | 1.82 [1.04] | | 1.94 [1.13] | | |
| Final Program Settings | | | | | | | | 0.86 |
| 1 | | 0 (0%) | | 0 (0%) | | 0 (0%) | | |
| 2 | | 0 (0%) | | 2 (3.8%) | | 2 (2.9%) | | |
| 3 | | 2 (11.1%) | | 4 (7.7%) | | 6 (8.6%) | | |
| 4 | | 2 (11.1%) | | 6 (11.5%) | | 8 (11.4%) | | |
| 5 | | 0 (0%) | | 7 (13.5%) | | 7 (10.0%) | | |
| 6 | | 3 (16.7%) | | 9 (17.3%) | | 12 (17.1%) | | |
| 7 | | 3 (16.7%) | | 9 (17.3%) | | 12 (17.1%) | | |
| A | | 3 (16.7%) | | 7 (13.5%) | | 10 (14.3%) | | |
| B | | 2 (11.1%) | | 3 (5.8%) | | 5 (7.1%) | | |
| C | | 1 (5.6%) | | 2 (3.8%) | | 3 (4.3%) | | |
| D | | 2 (11.1%) | | 3 (5.8%) | | 5 (7.1%) | | |
| Age at initial Implantation | | | | | | | | <0.01* |
| Median [Q1 - Q3] | | 66.0 [46.4 - 71.3] | | 71.8 [64.6 - 77.2] | | 70.5 [62.7 - 76.4] | | |
| Mean [SD] | | 59.7 [15.2] | | 70.6 [9.27] | | 68.0 [11.8] | | |
| Time from Implant to First Program Change | | | | | | | | 0.57 |
| Median [Q1 - Q3] | | 86.5 [33.3 - 230] | | 35.5 [29.0 - 368] | | 49.5 [29.0 - 290] | | |
| Mean [SD] | | 218 [313] | | 217 [289] | | 217 [293] | | |
| Device revision/replacement/removal | | | | | | | | 0.01* |
| No | | 16 (59.3%) | | 74 (84.1%) | | 90 (78.3%) | | |
| Yes | | 11 (40.7%) | | 14 (15.9%) | | 25 (21.7%) | | |
| Device Programming change | | | | | | | | 0.48 |
| No | | 6 (20.7%) | | 27 (29.0%) | | 33 (27.0%) | | |
| Yes | | 23 (79.3%) | | 66 (71.0%) | | 89 (73.0%) | | |
CONCLUSIONS: Sacral neuromodulation is promising for patients with NLUTD, but further study is needed to characterize differences in post-operative management for this group compared to the non-neurogenic population.
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