Abstract: PD09-08
Sources of Funding: Valley Medical Care Foundation

Introduction

Sacral neuromodulation (SNS) is approved by the Food and Drug Administration for the treatment of refractory urge urinary incontinence, frequency/urgency, idiopathic urinary retention and fecal incontinence. Prior to placement of an implantable pulse generator, all patients must undergo a trial stimulation to ensure improvement in their condition. The success rate for staged SNS implantation of a pulse generator (defined as > 50% improvement) varies greatly in the literature (ranging from 40 to 90%). We sought to determine success rates in California using a statewide registry.

Methods

We accessed non-public records from the California Office of Statewide Health Planning and Development (OSHPD) Ambulatory Surgery Database for the years 2005 to 2011. This dataset captures all non-federal ambulatory surgical visits within the state. Appropriate Current Procedural Terminology, 4th edition (CPT) procedure codes and International Classification of Disease, 9th edition (ICD-9) diagnosis codes were used to analyze all SNS procedures and their indication. Patients were followed longitudinally using unique patient record linkage numbers. Staged success was defined as the proportion of patients who received a stage 2 SNS generator implantation after their stage 1 tined lead trial.

Results

We identified 4,098 patients with SNS procedure codes. After excluding patients who only underwent generator exchange, lead revision or lead explantation, our final cohort included 2,765 patients. The majority of patients were female (77%), over 60 years of age (68%), Caucasian (74%) and had Medicare (60%). A total of 1,396 patients underwent a stage 1 trial of tined-lead implantation, of which 962 subsequently underwent stage 2 pulse generator placement (staged success rate of 69%). Staged success rates were 72% for urge urinary incontinence, 69% for urgency/frequency, 57% for urinary retention, 68% for interstitial cystitis and 67% for neurogenic bladder. Success rates were similar after stratification by race/ethnicity and insurance coverage.

Conclusions

While the success rates for staged SNS implantation in the state of California were less than that observed in many single center academic series; they are better than previously reported for Medicare patients, and suggestive of a success rate of greater than two thirds.

Funding

Valley Medical Care Foundation