Neuromodulation for Overactive Bladder Symptoms in Women Utilizing Either Motor or Sensory/Motor Provocation With a Minimum Nine-Year Follow-Up

IntroductionThis study is an evaluation of whether motor provocation compared to mixed sensory/motor provocation for tined lead placement affects its efficacy with quality of life measurements and Likert patient satisfaction. Materials and MethodsAn observational, retrospective cohort study was conducted with the analysis of 128 charts of adult women who, between January 2002 and September 2005, underwent a two-staged approach for sacral neuromodulation by the lead author SPM. Both groups did not differ statistically in their mean preoperative American Anesthesiologist Status Classification Score's of two or less, or frequency, urgency, urgency incontinence daily episodes or Urinary Distress Inventory scores. A seven-point Likert Scale was utilized for post-operative patient satisfaction. Sixty-eight patients (Group 1) received pure motor provocation for tined lead placement under general anesthetic and 60 patients (Group 2) received mixed sensory/motor provocation tined lead placement under intravenous sedation and local anesthetic. ResultsSixty-two of 68 (91%) patients in Group 1 proceeded to Stage Two while 53/60 (88%) in Group 2 proceeded to Stage Two implantation (p = 0.28). Median follow-ups were 124.7 21.5 months for Group 1 and 120.4 +/- 19.7 months for Group 2 (p = 0.45). Mean preoperative/postoperative Urinary Distress Inventory short form and number of voids per 24 hours were for Group 1, 15.5 +/- 6.6/8.9 +/- 4.3 and 16.3 +/- 5.3/9.2 +/- 3.9 and for Group 2, 16.3 +/- 6.4/8.4 +/- 3.9 and 17.82 +/- 7.17/8.34 +/- 4.26 voids/24 hours (p < 0.001). Mean preoperative and postoperative ultrasound post void residual urines were 62.2 +/- 29.3 milliliters/46.9 +/- 20.6 milliliters (Group 1) and 68.0 +/- 26.8 milliliters /42.0 +/- 27.8 milliliters (Group 2) (p < 0.01). Mean operative times were 29.5 +/- 16.8 minutes (Group 1) and 59.3 +/- 25.8 minutes (Group 2) (p < 0.001). Mean Likert patient satisfaction score (1, 2, 3) for Group 1 was 2.6 and 1.8 for Group 2 (p < 0.21). The mean numbers of office visits/year for reprogramming were 1.4 +/- 0.7 (Group 1) and 2.8 +/- 1.1 (Group 2) (p < 0.001). ConclusionWomen with mixed sensory/motor provocation tined lead placement incurred statistically significant longer operating room times and an increased number of annual reprogramming sessions. Singular motor provocation tined lead placement may, in fact, improve outcomes by significantly decreasing operating room time, improving patient satisfaction, and decreasing mean yearly reprogramming sessions, compared to mixed sensory/motor tined lead placement.