Sacral neuromodulation for overactive bladder in women: do age and comorbidities make a difference?

To evaluate if age and comorbidities are associated with progression from trial phase to implantation of an implantable pulse generator in women with overactive bladder.

This multisite retrospective cohort included women with overactive bladder with or without urinary incontinence who had a trial phase for sacral neuromodulation. The primary outcome was progression to implantation. A sub-analysis of implanted patients was performed for the outcome of additional therapies or "implant only" for the duration of follow-up. Multivariate logistic regression models including potential predictors of implantation and post-implantation addition of therapies were performed.

At six academic institutions, 91% (785/864) of patients progressed to implantation. Post-implantation success was achieved by 69% (536/782) of patients at median follow-up of 2 (range 0.3 to 15) years. Odds of implantation [OR 0.73 (CI 0.61, 0.88)] and post-implantation success [OR 0.78 (CI 0.98, 0.97)] were lower with increasing decades of age. Medical comorbidities evaluated did not affect implantation rates or post-implant success.

Most women have successful sacral neuromodulation trials despite older age and comorbidities. Higher decade of age has a negative effect on odds of implantation and is associated with addition of therapies post-implantation. Comorbidities assessed in this study did not affect implantation or addition of therapies post-implantation. Most women add therapies to improve efficacy post-implantation, and explantation rates are low.

International urogynecology journal. 2020 Jun 25 [Epub ahead of print]

Rachel A High, William Winkelman, Joseph Panza, Derrick J Sanderson, Hyde Yuen, Gabriela Halder, Courtney Shaver, Erin T Bird, Rebecca G Rogers, Jill M Danford

Department of Obstetrics and Gynecology, Baylor Scott & White Health, 2401 South 31st Street, Temple, TX, 76508, USA. ., Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and the Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA., Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA., Department of Obstetrics and Gynecology University of Rochester School of Medicine & Dentistry, Rochester, NY, USA., Department of Obstetrics and Gynecology, Christ Hospital, Cincinnati, OH, USA., Dell School of Medicine, University of Texas, Austin, TX, USA., Office of Biostatistics Baylor Scott & White, Temple, TX, USA., Department of Urology Baylor Scott & White Health, Temple, TX, USA.