Medical College of Wisconsin
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Predicting success using response after lead implantation with sacral neuromodulation for urgency incontinence. Neurourol Urodyn 2024 Nov;43(8):1776-1783

Date

07/30/2024

Pubmed ID

39075815

Pubmed Central ID

PMC11495989

DOI

10.1002/nau.25562

Scopus ID

2-s2.0-85199993375 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

IMPORTANCE: Many women report inadequate symptom control after sacral neuromodulation (SNM), despite 50% reduction in urgency incontinence episodes (UUIE) after test stimulation.

OBJECTIVE: To determine the ideal percent UUIE reduction after test stimulation that predicts 24-month success.

STUDY DESIGN: Using data from a multicenter SNM trial, we constructed receiver operating characteristic curves to identify an ideal threshold of percent UUIE reduction after test stimulation. We defined 24-month success as Patient Global Impression of Improvement of "very much better" to "better." We compared predictive accuracy of two models predicting success: (1) percent UUIE reduction alone and (2) with baseline characteristics.

RESULTS: Of 149 women (median [IQR] baseline daily UUIE 4.7 [3.7, 6.0]), the ideal threshold for 24-month success was 72% (95% confidence interval 64,76%) UUIE reduction with accuracy 0.54 (0.42, 0.66), sensitivity 0.71 (0.56, 0.86) and specificity 0.27 (0.05, 0.55). The accuracy of the 50% reduction threshold was 0.60 (0.49, 0.71), sensitivity 0.95 (0.88, 1.0) and specificity 0.04 (0.0, 0.12). Percent reduction in UUIE was not better than chance in predicting 24-month success (concordance index [c-index] 0.47 [0.46, 0.62]); adding age, body mass index, diabetes mellitus and visual or hearing impairment the c-index was 0.68 (0.61, 0.78).

CONCLUSIONS: Among women who received an internal pulse generator (IPG) due to ≥50% UUIE reduction after test stimulation, we found no ideal threshold that better predicted 24-month success. Percent reduction in UUIE after test stimulation poorly predicts 24-month success with or without clinical factors. Given this, re-evaluating how we determine who should receive an IPG is needed.

Author List

Hendrickson WK, Zhang C, Hokanson JA, Nygaard IE, Presson AP

Author

James A. Hokanson PhD Assistant Professor in the Biomedical Engineering department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Electric Stimulation Therapy
Female
Humans
Implantable Neurostimulators
Lumbosacral Plexus
Middle Aged
Predictive Value of Tests
ROC Curve
Time Factors
Treatment Outcome
Urinary Incontinence, Urge