A modified approach to patient's selection with improved clinical outcomes in sacral nerve modulation

Introduction: Since the marketing of the percutaneous permanent tined leads (PPTL), many centres rely solely on these instead of the percutaneous nerve evaluation (PNE) as a screening tool. At our centre, we routinely perform PNE. Moreover, with our limited hospital resources, we have adopted a stricter definition of success in the patient selection process using an improvement of more than 60% as a cut-off point. This study presents our experience with sacral nerve stimulation using PPTL as an adjunct to PNE to improve the outcome of the screening method for patients suffering from refractory voiding dysfunction. Methods: We reviewed the charts of 106 patients who underwent a PNE between 2001 and 2008. The outcome of the procedures, the complication rates and its long-term effect were reviewed. Results: Overall, 116 PNE were performed and it was successful in 54%. Forty-five out of the 62 patients with a successful PNE underwent the stage I procedure. Of these, 93% had a successful stage I and were later implanted with the implantable pulse generator (IPG). The remaining 12 patients underwent the simultaneous implantation of the PPTL and IPG using the open procedure and it was successful in 10 of them. Conclusion: The PNE is a good adjunct to the staged procedure to select the appropriate candidates for sacral nerve stimulation, especially with limited resources.