Sacral Neuromodulation Reprogramming Rates: Understanding Office-Based Requirement

Abstract

Importance: Sacral neuromodulation (SNM) is a procedure with the advantage of reprogramming for discomfort or inadequate symptom control.

Objectives: The aims of this study were to investigate the rates of office-based SNM programming in a large multisite cohort and to examine differences based on implantation indication.

Study design: The TriNetX database was utilized for retrospective cohort comparison using International Classification of Diseases, Tenth Revision, and Current Procedural Terminology (CPT) codes. Cohort selection included female adults with a diagnosis of urinary retention, urgency urinary incontinence, and/or fecal incontinence (FI) at time of implantation. The primary outcome was the rate of SNM reprogramming CPT per individual from 6 weeks to 5 years postimplantation. Secondary outcomes included demographic comparisons, incidence, and survival curves for patients with SNM reprogramming identified with CPT codes. Further comparisons were completed between implantation diagnoses of grouped urinary (urgency and retention) versus fecal indications.

Results: A total of 9,501 patients meet inclusion criteria with a mean of age 62.1 ± 14.9 years (range, 18-90). Office-based SNM reprogramming was identified in 31.5%. The probability of never having reprogramming at 5 years was 52.5%. The mean number of reprogramming sessions was 2.5 ± 2.1. Approximately half (48%) of the patients with FI also had a diagnosis of urgency urinary incontinence, and approximately 25% had urinary retention. The probability of never having reprogramming was 55% and higher in patients with a fecal incontinence indication than those with only urinary indications at 50%, P < 0.001.

Conclusions: Office-based SNM reprogramming occurs in 31.5% of patients with implants, and rates are likely underreported. Patients with any FI diagnosis have a higher risk of requiring reprogramming.