title: Reoperation after sacral neuromodulation therapy: a single-institution experience.
abstract: OBJECTIVE
  Sacral neuromodulation has become an accepted treatment for various types of lower urinary tract dysfunction. However, despite technologic advances in device implantation and a trial stimulation period, sacral neuromodulation still has a significant reoperation rate. We report our single-institution experience of reoperation rates.
  
  
  METHODS
  We performed a retrospective review of our patients who had undergone the implantation of the InterStim device from April 1999 to December 2011 for lower urinary tract dysfunction.
  
  
  RESULTS
  A total of 155 InterStim devices were implanted by 2 surgeons. Of the 142 patients with complete follow-up, 55 (38.2%) patients required reoperation, for either revision or explantation of the device. Revisions were performed in 30 (21.1%) patients, most commonly for mechanical failure of device, battery end-of-service, and pain, either at the site of the implanted pulse generator or with stimulation. Of the 30 patients who underwent revision, 14 had successful results, 6 had persistent symptoms, and 10 progressed to eventual explantation.The overall explantation rate was 24.6% (35 of 142 patients), and the average time to removal was 44 months. Most of the explantations were performed for poor symptom control and failure to maintain response (74.3%).Reoperation was not associated with age, sex, obesity, diabetes, chronic pain, use of the tined lead, or type of lower urinary tract dysfunction.
  
  
  CONCLUSIONS
  Sacral neuromodulation has a substantial revision and explantation rate, without any clear predictors for these complications. Patients should be counseled to these complications before surgery.
authors.affiliation: Department of Urology, University of Washington, Seattle, WA 98195, USA. csshih@uw.edu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Shih
authors.forename: Jane L
authors.initials: JL
authors.lastname: Miller
authors.forename: Michael
authors.initials: M
authors.lastname: Fialkow
authors.forename: Brenda G
authors.initials: BG
authors.lastname: Vicars
authors.forename: Claire C
authors.initials: CC
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D014555:Urination Disorders / Q000601:surgery / Q000628:therapy*; D055815:Young Adult