Long-Term Outcome and Surgical Interventions After Sacral Neuromodulation Implant for Lower Urinary Tract Symptoms: 14-Year Experience at 1 Center Ali A. Al-zahrani,* Ehab A. Elzayat and Jerzy B. Gajewski† From the Departments of Urology, Dalhousie University (AAA, EAE, JBG), Halifax, Nova Scotia, Canada, and University of Dammam (AAA), Dammam, Saudi Arabia Purpose: Few reports address the reoperation rate after sacral neuromodulation implants. We report our long-term results and reoperations during our 14-year experience with sacral neuromodulation at our center. Materials and Methods: We retrospectively reviewed the patient database at our center to assess the long-term outcome, incidence and cause of surgical re- intervention after InterStim® sacral neuromodulation implantation for lower urinary tract dysfunction between 1994 and 2008. Results: A total of 96 sacral neuromodulation devices were implanted in 88 women and 8 men. Indications for implantation were bladder pain syndrome in 47.9% of cases, urgency urinary incontinence in 35.4% and idiopathic urinary retention in 16.7%. The explantation rate was 20.8% and median time to removal was 18.5 months. Reasons for explantation in all subgroups were poor result in 12 patients, painful stimulation in 6 and radiation of stimula- tion to the leg in 2. Median long-term followup was 50.7 months. The long- term success rate was 87.5%, 84.8% and 73% in patients with idiopathic urinary retention, urgency urinary incontinence and bladder pain syndrome, respectively. Overall 39% of patients needed revision of the sacral neuromodu- lation implant. The main reason for revision was loss of stimulation in 58.5% of cases. The revision rate decreased with the introduction of the tined lead technique from 50% using lead Model 3092 to 31% using lead Model 3893 (Medtronic, Minneapolis, Minnesota). The battery was changed in 8 patients. Mean battery life was 101.8 months. Conclusions: Sacral neuromodulation is a minimally invasive procedure with a good long-term outcome. The reoperation rate has improved with advances in surgical technique and equipment. Key Words: urinary bladder; pain; urinary incontinence, urge; electric stimulation; prostheses and implants Abbreviations and Acronyms BPS = bladder pain syndrome FDA = Food and Drug Administration GRA = global response assessment scale IPG = implanted pulse generator IUR = idiopathic urinary retention PNE = percutaneous nerve evaluation SNM = sacral neuromodulation UUI = urgency urinary incontinence Submitted for publication June 23, 2010. Study received institutional ethics board ap- proval. * Correspondence: QEII Health Science Cen- tre, HI Site, 1225B-1796 Summer St., Halifax, Nova Scotia, B3H 3A7 Canada (telephone: 902- 473-8679; FAX: 902-473-8568; e-mail: ahzhrani@ yahoo.com). † Financial interest and/or other relationship with Astellas, Allergan, Medtronic, Lilly and Pfizer. THE concept of sacral nerve stimula- tion was introduced in 1979 by Schmidt et al. 1 Currently SNM is approved by the United States FDA for refrac- tory UUI, urinary frequency/ur- gency syndrome and nonobstructive IUR. 2 SNM is also approved in other countries. Several studies show the safety and efficacy of SNM at short-term and medium term followup but SNM remains expensive with the addi- tional costs of reoperation, revision and battery exchanges. 3 Thus, it is important to review SNM long-term outcomes and revision rates. We re- 0022-5347/11/1853-0981/0 Vol. 185, 981-986, March 2011 THE JOURNAL OF UROLOGY ® Printed in U.S.A. © 2011 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH,INC. DOI:10.1016/j.juro.2010.10.054 www.jurology.com 981