Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice

T.C. Dudding*, P.A. Lehur, M. Sorensen, S. Engelberg, M.P. Bertapelle, E. Chartier-Kastler, K. Everaert, P. Van Kerrebroeck, C.H. Knowles, L. Lundby, K.E. Matzel, A. Munoz-Duyos, M.B. Rydningen, S. de Wachter

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

Abstract

Objectives In some patients treated for urinary or fecal incontinence with sacral neuromodulation (SNM) persistence of symptoms, a reduction in efficacy or adverse effects of stimulation can occur. In such situations, further programming of the SNM device can help resolve problems. Infrequently hardware failure is detected. This article aims to provide practical guidance to solve sub-optimal outcomes (troubleshooting) occurring in the course of SNM therapy. Materials and Methods A systematic literature review was performed. Collective clinical experience from an expert multidisciplinary group was used to form opinion where evidence was lacking. Results Circumstances in which reprogramming is required are described. Actions to undertake include changes of electrode configuration, stimulation amplitude, pulse frequency, and pulse width. Guidance in case of loss of efficacy and adverse effects of stimulation, developed by a group of European experts, is presented. In addition, various hardware failure scenarios and their management are described. Conclusions Reprogramming aims to further improve patient symptoms or ensure a comfortable delivery of the therapy. Initial changes of electrode configuration and adjustment of stimulation parameters can be performed at home to avoid unnecessary hospital visits. A logical and stepwise approach to reprogramming can improve the outcome of therapy and restore patient satisfaction.
Original languageEnglish
Pages (from-to)1247-1257
Number of pages11
JournalNeuromodulation
Volume24
Issue number7
Early online date15 Jul 2021
DOIs
Publication statusPublished - Oct 2021

Keywords

  • Fecal incontinence
  • reprogramming
  • sacral neuromodulation
  • troubleshooting
  • urinary incontinence
  • OVERACTIVE BLADDER SYMPTOMS
  • MULTIPLE-SCLEROSIS PATIENTS
  • NERVE-STIMULATION
  • FECAL INCONTINENCE
  • FOLLOW-UP
  • SINGLE-CENTER
  • VOIDING DYSFUNCTION
  • CONSTANT-CURRENT
  • MULTICENTER
  • EFFICACY

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