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For Patients Treated with Sacral Neuromodulation, Complications or Use of Hormone Replacement Therapy May Predict Risk of Reoperation

Peters KM, Killinger KA, Gilleran JP, Bartley J, Wolfert C, Boura JA. Predictors of reoperation after sacral neuromodulation: A single institution evaluation of over 400 patients. Neurourol Urodyn. 2015 Nov 20. doi: 10.1002/nau.22929. [Epub ahead of print]

There is some evidence that patients with interstitial cystitis/bladder pain syndrome (IC/BPS) can benefit from sacral neuromodulation, a procedure that involves implanting a wire that sends mild electrical impulses to nerves around the tailbone. However, one significant risk of the procedure is the need for a second operation, either to remove the wire or to reposition it. Exactly who will need such a reoperation is not precisely known. To see if there are any particular factors that predisposed patients to needing a reoperation, investigators in this study reviewed a database of 407 patients who underwent sacral neuromodulation. About one-third of the 407 patients underwent reoperation at some point over the follow-up period (a median of 2 years). A little more than half of the reoperations were revisions, while the remainder were procedures to remove the device. The most common reason for reoperation was a lack of efficacy or worsening symptoms. Investigators found that having a complication was a significant predictor of a second operation. Also, among the women in the study, using hormone replacement therapy at the time of implant also predicted the need for reoperation. However, further study is needed on this evolving technology to more clearly define who is at higher risk of reoperation.