The impact of handedness on sacral neuromodulation outcomes for lower urinary tract dysfunction: Does ipsilateral or contralateral lead placement matter?

Introduction Sacral neuromodulation (SNM) is an effective treatment for overactive bladder and non-obstructive urinary retention. The side of lead placement is currently chosen on basis of perioperative factors and preference of the surgeon. Studies have shown that motor control is performed primarily by the contralateral brain hemisphere. However, this is not accounted for in SNM. This study aimed to investigate whether a match between patient handedness and lead side correlates with SNM test phase success. Methods Retrospectively data of patients treated with SNM at Maastricht UMC+ between 1995 and 2025 on age, sex, diagnosis, handedness, lead side, and test outcome were analysed. The primary outcome was test phase success. Logistic regression was used to assess associations. Results Among 453 patients there was a progress to IPG implantation rate of 70%. Matching handedness and lead side was associated with a higher odds of success (OR = 1.98, p = 0.067). Left-handed patients had significantly higher odds of success (OR = 2.18, p = 0.037). Moreover younger and female patients tended to have a better success percentage. Limitations are the retrospective nature, informal assessment of handedness and the large amount of missing data. Conclusion Matching dominant hand and lead side may be associated with higher success, and left-handed patients appear to have better outcomes. Until more definitive evidence is available, we propose selecting the ipsilateral sacral foramen concordant with patient handedness for lead placement to increase the results of the SNM test phase.