Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice
Dudding TC, Lehur PA, Sorensen M, Engelberg S, Bertapelle MP, Chartier-Kastler E, Everaert K, Van Kerrebroeck P, Knowles CH, Lundby L, Matzel K, Munoz-Duyos A, Rydningen MB, De Wachter S (2021)
Publication Type: Journal article, Review article
Publication year: 2021
Journal
DOI: 10.1111/ner.13494
Abstract
Objectives: In some patients treated for urinary or fecal incontinence with sacral neuromodulation (SNM) persistence of symptoms, a reduction in efficacy or adverse effects of stimulation can occur. In such situations, further programming of the SNM device can help resolve problems. Infrequently hardware failure is detected. This article aims to provide practical guidance to solve sub-optimal outcomes (troubleshooting) occurring in the course of SNM therapy. Materials and Methods: A systematic literature review was performed. Collective clinical experience from an expert multidisciplinary group was used to form opinion where evidence was lacking. Results: Circumstances in which reprogramming is required are described. Actions to undertake include changes of electrode configuration, stimulation amplitude, pulse frequency, and pulse width. Guidance in case of loss of efficacy and adverse effects of stimulation, developed by a group of European experts, is presented. In addition, various hardware failure scenarios and their management are described. Conclusions: Reprogramming aims to further improve patient symptoms or ensure a comfortable delivery of the therapy. Initial changes of electrode configuration and adjustment of stimulation parameters can be performed at home to avoid unnecessary hospital visits. A logical and stepwise approach to reprogramming can improve the outcome of therapy and restore patient satisfaction.
Authors with CRIS profile
Involved external institutions
University Hospital Southampton NHS
United Kingdom (GB)
Hvidovre Hospital
Denmark (DK)
Universiteit Gent (UGent) / Ghent University
Belgium (BE)
Queen Mary University of London
United Kingdom (GB)
University of Antwerp / Universiteit Antwerpen
Belgium (BE)
Medtronic International Trading Sàrl
Switzerland (CH)
Ospedale Regionale di Lugano - Civico e Italiano
Switzerland (CH)
Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino
Italy (IT)
Aarhus University Hospital / Aarhus Universitetshospital
Denmark (DK)
University Hospital of North Norway / Universitetssykehuset Nord-Norge (UNN)
Norway (NO)
University of Paris 4 - Paris-Sorbonne / Université paris IV Paris-Sorbonne
France (FR)
Universitat de Barcelona (UB) / University of Barcelona
Spain (ES)
Maastricht University
Netherlands (NL)
United Kingdom (GB)
Hvidovre Hospital
Denmark (DK)
Universiteit Gent (UGent) / Ghent University
Belgium (BE)
Queen Mary University of London
United Kingdom (GB)
University of Antwerp / Universiteit Antwerpen
Belgium (BE)
Medtronic International Trading Sàrl
Switzerland (CH)
Ospedale Regionale di Lugano - Civico e Italiano
Switzerland (CH)
Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino
Italy (IT)
Aarhus University Hospital / Aarhus Universitetshospital
Denmark (DK)
University Hospital of North Norway / Universitetssykehuset Nord-Norge (UNN)
Norway (NO)
University of Paris 4 - Paris-Sorbonne / Université paris IV Paris-Sorbonne
France (FR)
Universitat de Barcelona (UB) / University of Barcelona
Spain (ES)
Maastricht University
Netherlands (NL)
How to cite
APA:
Dudding, T.C., Lehur, P.A., Sorensen, M., Engelberg, S., Bertapelle, M.P., Chartier-Kastler, E.,... De Wachter, S. (2021). Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice. Neuromodulation. https://doi.org/10.1111/ner.13494
MLA:
Dudding, Thomas C., et al. "Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice." Neuromodulation (2021).
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