title: In patients undergoing neuromodulation for intractable urge incontinence a reduction in 24-hr pad weight after the initial test stimulation best predicts long-term patient satisfaction.
abstract: OBJECTIVE
  To evaluate long-term patient satisfaction of sacral neuromodulation and to correlate satisfaction with incontinence parameters.
  
  
  METHODS
  Patients at least 1-year remote from sacral neuromodulation were mailed a questionnaire to evaluate satisfaction and assess incontinence symptoms.
  
  
  RESULTS
  Fifty-two patients were consecutively enrolled in the study. Forty-nine questionnaires (94.2%) were returned. The average interval between implantation and questionnaire completion was 27.2 (range 12-52) months. 83.7% of respondents were satisfied and 79.6% of patients would "do it all over again." Compared to dissatisfied subjects during test stimulation, the satisfied patients had a significant decrease in 24-hr pad weight (84.5% vs. 60.6%, P = 0.002) but did not differ in daily pad usage (4.5 fewer pads per day vs. 3.4, P = 0.190). At long-term follow-up, satisfied patients noted significantly greater improvement in their Incontinence Impact Questionnaire score versus dissatisfied patients (mean improvement 53 vs. 10 points, P = 0.0003). Using multiple logistic regression, change in 24-hr pad weight, but not change in average daily pad usage, was correlated with long-term satisfaction.
  
  
  CONCLUSIONS
  Eighty-four percent of patients were satisfied with sacral neuromodulation at a mean of 27 months. An 84.5% reduction in 24-hr pad weight correlated with long-term patient satisfaction. In addition to lack of efficacy, device pain was a contributing factor to dissatisfaction.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Duke University Medical Center, Durham, NC 27710, USA. raymond.foster@duke.edu
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Foster
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Anoia
authors.forename: George D
authors.initials: GD
authors.lastname: Webster
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
mesh_terms: D000368:Aged; D016208:Databases, Factual; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D016496:Incontinence Pads; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010525:Peripheral Nerves / Q000502:physiology; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D053202:Urinary Incontinence, Urge / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*