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Single-stage procedure an independent predictor of SNM device explant/revision

Opinion
Video

"I think these findings suggest that for clinicians who treat a lot of older adults with neuromodulation, caution should be exhibited when recommending the single-stage approach," says Leo Dreyfuss, MD.

In this video, Leo Dreyfuss, MD, discusses trends observed in 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:

One-year explant/revision rates were significantly higher for single-stage procedures vs PNE. What aspects of the single-stage approach do you think might contribute to this finding?

Yes, about 25% of stage 1 procedures were performed with simultaneous device implantation, and about 20% of these residents ultimately progressed to device explant or revision within 1 year. We found that single-stage procedures were an independent predictor of device explant or revision compared to stage 1 or PNE. So there's definitely some potential cost savings associated with single-stage procedures. There was actually an interesting analysis out of Virginia Mason in 2020 that cited some cost savings associated with this approach. However, in that study, they assumed that only 1 in 15 patients would ultimately go on from implant to explant, which is quite a bit different from the 1 in 5 patients who ultimately underwent explantation after single-stage procedures in this study. So I think these findings suggest that for clinicians who treat a lot of older adults with neuromodulation, caution should be exhibited when recommending the single-stage approach. However, I think future studies are needed to look at the potential role of the single-stage approach in younger populations or healthier populations.

This transcription was edited for clarity.

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