title: Predictors of reoperation after sacral neuromodulation: A single institution evaluation of over 400 patients.
abstract: To explore factors that may predispose patients to reoperation after sacral neuromodulation (SNM).
  
  
  
  Patients enrolled in our longitudinal neuromodulation database were reviewed. Medical records data, and voiding diaries, Interstitial Cystitis Symptom-Problem Indices (ICSI-PI), and Overactive Bladder Questionnaires (OAB-q) at baseline and 3 months were analyzed with Pearson's χ2, Fisher's Exact test, Wilcoxon rank tests, and multivariable logistic regression.
  
  
  
  Of 407 patients, 134 (33%) had at least one reoperation over median 28.9 months follow-up (range 1.6-121.7); 78/407 (19%) were revised, and 56/407 (14%) were explanted. The most common reason for reoperation was lack of efficacy/worsening symptoms (n = 87). The reoperations group had a higher proportion of women (P = 0.049), lower mean body mass index (BMI; P = 0.010), more reprogramming events (P < 0.0001), longer median follow-up (P = 0.0008), and higher proportions with interstitial cystitis (P = 0.013), using hormone replacement therapy (P = 0.0004), and complications (P < 0.0001). Both reoperations/no reoperations groups had similar improvements in ICSI-PI (P < 0.0001 for both), OAB-q severity (P < 0.0001 for both) and quality of life (P < 0.0001 for both). On multivariate analysis, only longer follow-up (P = 0.0011; OR 1.048; CI 1.019, 1.078) and having a complication (P < 0.0001; OR 23.2; CI 11.47, 46.75) were significant predictors of reoperations. In women only, using HRT at time of implant was also predictive of reoperation (P = 0.0027; OR 3.09; CI 1.48, 6.46).
  
  
  
  In this largest known series to date, one third of the patients required reoperation and the most common reason was lack of efficacy/worsening symptoms. Ongoing study is needed as the technology continues to evolve. Neurourol. Urodynam. 36:354-359, 2017. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Beaumont Health System, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Rochester, Michigan.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Peters
authors.affiliation: Beaumont Health System, Royal Oak, Michigan.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Killinger
authors.affiliation: Beaumont Health System, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Rochester, Michigan.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Gilleran
authors.affiliation: Beaumont Health System, Royal Oak, Michigan.
authors.forename: Jamie
authors.initials: J
authors.lastname: Bartley
authors.affiliation: Beaumont Health System, Royal Oak, Michigan.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Wolfert
authors.affiliation: Beaumont Health System, Royal Oak, Michigan.|Oakland University William Beaumont School of Medicine, Rochester, Michigan.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Boura
mesh_terms: D000328:Adult; D000368:Aged; D018856:Cystitis, Interstitial / Q000503:physiopathology / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008875:Middle Aged; D012086:Reoperation; D012447:Sacrum / Q000601:surgery*; D004561:Transcutaneous Electric Nerve Stimulation; D053201:Urinary Bladder, Overactive / Q000503:physiopathology / Q000601:surgery*
keywords: electrical stimulation therapy; lower urinary tract symptoms; urinary Incontinence; urinary bladder, overactive