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Region Hovedstaden - en del af Københavns Universitetshospital
E-pub ahead of print

Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice

Publikation: Bidrag til tidsskriftReviewpeer review

DOI

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  2. Sacral Neuromodulation: Standardized Electrode Placement Technique

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  • Thomas C Dudding
  • Paul A Lehur
  • Michael Sørensen
  • Stefan Engelberg
  • Maria Paola Bertapelle
  • Emmanuel Chartier-Kastler
  • Karel Everaert
  • Philip Van Kerrebroeck
  • Charles H Knowles
  • Lilli Lundby
  • Klaus E Matzel
  • Arantxa Muñoz-Duyos
  • Mona B Rydningen
  • Stefan de Wachter
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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.

OriginalsprogEngelsk
TidsskriftNeuromodulation
ISSN1094-7159
DOI
StatusE-pub ahead of print - 15 jul. 2021

ID: 66726706