To evaluate the impact of cognitive impairment (CI) on sacral neuromodulation (SNM) outcomes in older patients, including progression to full implant, patient-reported outcome measures, and device utilization.
This prospective trial recruited patients age ≥ 60 years scheduled for test-phase SNM for refractory overactive bladder (OAB). Screening for CI was completed and defined as Montreal Cognitive Assessment scores < 26/30.Patients underwent initial and follow-up assessments using validated questionnaires (OAB-q SF, IIQ7, UDI-6, PGI-I). Baseline functional status and technology comfort/use were assessed by novel questionnaire. The primary outcome of test-phase success (>50% improvement in baseline symptoms) was compared based on the presence of CI. Secondary outcomes included urinary questionnaire scores and device utilization.
Of 92 patients recruited, 88 underwent test-phase SNM (mean age 73 ± 8 years, 89% female), and 63% had CI (Montreal Cognitive Assessment < 26). Baseline patient-reported measures of OAB symptom severity and impact were not statistically different between groups. Patients with CI had lower baseline technology use and confidence. Overall test-phase success was 89% and did not differ based on CI (91% vs 87%, P = .7). At 1-month follow-up, patients with CI demonstrated lower rates of appropriate SNM controller use; however, patient-reported outcomes did not differ.
Older patients with OAB presenting for SNM have a high incidence of CI, which is associated with reduced comfort using technology. However, there was no evidence that CI affected SNM test-phase success or short-term patient-reported outcomes.
The Journal of urology. 2025 Jul 30 [Epub ahead of print]
Chen Shenhar, Howard B Goldman, Emily Slopnick, Marieke K Jones, Bradley Gill, Jacqueline Zillioux
Urogynecology and Reconstructive Pelvic Surgery, Glickman Urologic Institute and Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio., Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.