PNE vs Stage 1 lead placement compared for rate of progression to SNM device implantation

In this video, Leo Dreyfuss, MD, discusses the Neurourology and Urodynamics paper, “Sacral neuromodulation in nursing home residents: Predictors of success and complications in a national cohort of older adults.” Dreyfuss is a urology resident at NewYork-Presbyterian Hospital/Weill Cornell Medical, New York, New York.

Transcription:

The success rate of PNE for residents who progressed to device implant was lower than that of Stage 1. Can you elaborate on possible reasons for this difference?

In the study, about two thirds of the residents did undergo PNE and one third underwent Stage 1, and those who underwent PNE were less likely to progress to device implant than Stage 1. While the 2 groups, looking at table 1, were fairly well balanced, those who underwent Stage 1 were more likely to be female, and looking at our primary outcome of device implant on multivariable analysis, female sex was an independent predictor of progression from test period to device implant. And this could be due to some inherent differences between the PNE leads and Stage 1 leads. It's not necessarily a new finding. There's a retrospective study that looked at this outcome and found that patients who underwent PNE were less likely to report subjective symptom improvement compared to stage 1; it's possible that these leads become dislodged or prone to migration, which can result in false negative results. It's also possible that patients who undergo Stage 1, because it's a more invasive procedure, they may be just inherently more invested in the neuromodulation treatment, more likely to report subjective symptoms and progress to device implantation. That said, this is an evolving field. I know there are some emerging technologies that have been recently developed that are meant to improve the performance of PNE performed in the office setting. As those technologies become utilized more often, it'll definitely be important to re-perform these analyses in updated data once those technologies have had a chance to percolate into the field. It'll be interesting to see if anything changes.

This transcription was edited for clarity.