1186: Management Strategies for the Migration of Percutaneous Tined Leads for Sacral Neuromodulation

INTRODUCTION AND OBJECTIVE: In refractory cases of urge/frequency/pain syndrome, urge incontinence, or non-obstructive retention, sacral neuromodulation (SNM) has proven to be a viable therapeutic option.There is little information about the expectations for the SNM patient with regards to long term use.The purpose of this study is to review the long term management of SNM beyond the first 24 months.METHODS: We retrospectively reviewed the medical records of all 72 patients undergoing SNM testing via lnterStim (Medtronics, Minneapolis, MN) from Jan 1998 to Oct 2006 at our institution.We collected data on duration of implantation, reprograms, revisions and complications.We focused on patients with a minimum of 24 months follow-up.RESULTS: Twenty-one patients were identified to have SNM use beyond 24 months with an average age of 51.8 (28-77) years and a mean follow up of 50.5 (29-96) months.Fifty-one patients were not included in this review because 17 patients failed SNM testing and 34 patients have not yet reached 24 months of follow-up or had their SNM's removed prior to 24 months.Indications for SNM included refractory urge/frequency/pain syndrome in 13 (62%) patients, urge incontinence in 4 (19%) patients and non-obstructive retention in 4 (19%) patients.They required an average of 2.3 (1.0-3.8)SNM reprograms per year with 6 (29%) patients requiring greater than 3 reprograms per year.Thirteen (62%) patients required a total of 25 operative revisions with a mean of 1.9 (1-5) per patient.Five (24%) SNM units were explantated on average at 42.2 (31-58) months and batteries were changed after an average of 55.7 (46-70) months.CONCLUSIONS: This study is one of the longest reported series of SNM use.It highlights the chronic care and maintenance that urologists and patients with SNM can expect.Patients with long term implantation of lnterStim SNM require continuous maintenance including reprograms, revisions, and removals.