Reoperation After Sacral Neuromodulation Therapy: A Single-Institution Experience

Objectives: Sacral neuromodulation has become an accepted treatment for various types of lower urinary tract dysfunction. However, despite technologic advances in device implantation and a trial stimulation period, sacral neuromodulation still has a significant reoperation rate. We report our single-institution experience of reoperation rates. Methods: We performed a retrospective review of our patients who had undergone the implantation of the InterStim device from April 1999 to December 2011 for lower urinary tract dysfunction. Results: A total of 155 InterStim devices were implanted by 2 surgeons. Of the 142 patients with complete follow-up, 55 (38.2%) patients required reoperation, for either revision or explantation of the device. Revisions were performed in 30 (21.1%) patients, most commonly for mechanical failure of device, battery end-of-service, and pain, either at the site of the implanted pulse generator or with stimulation. Of the 30 patients who underwent revision, 14 had successful results, 6 had persistent symptoms, and 10 progressed to eventual explantation. The overall explantation rate was 24.6% (35 of 142 patients), and the average time to removal was 44 months. Most of the explantations were performed for poor symptom control and failure to maintain response (74.3%). Reoperation was not associated with age, sex, obesity, diabetes, chronic pain, use of the tined lead, or type of lower urinary tract dysfunction. Conclusions: Sacral neuromodulation has a substantial revision and explantation rate, without any clear predictors for these complications. Patients should be counseled to these complications before surgery.