title: Impact of Age and Comorbidities on Use of Sacral Neuromodulation.
abstract: We investigated the influence of patient age on sacral nerve stimulation trial outcomes, device implantation and treatment durability.
  
  
  
  We analyzed a database of all sacral nerve stimulation procedures performed between 2012 and 2014 at a high volume institution for associations of patient age with sacral nerve stimulation indication, trial stimulation success, device revision and device explantation.
  
  
  
  In a cohort of 356 patients those with nonobstructive urinary retention and urgency-frequency were younger than patients with urgency urinary incontinence. Trial stimulation success did not differ by age in stage 1 and percutaneous nerve evaluation trials (p = 0.51 and 0.84, respectively). Logistic regression identified greater odds of trial success in females compared to males (OR 2.97, 95% CI 1.32-6.04, p = 0.009) and for urgency urinary incontinence compared to urgency-frequency (OR 3.02, 95% CI 1.39-6.50, p = 0.006). In analyzed patients there were 119 surgical revisions, including battery replacement, and 53 explantations. Age was associated with a decreased risk of revision with 3% lower odds per each additional year of age (OR 0.97, 95% CI 0.95-0.98, p <0.0001). While age did not influence explantation, for each body mass index unit there was a 5% decrease in the odds of explantation (OR 0.95, 95% CI 0.91-0.98).
  
  
  
  In contrast to previous studies, older patients experienced no difference in the sacral nerve stimulation response in stimulation trials and no difference in the implantation rate. Furthermore, age was modestly protective against device revision. This suggests that age alone should not negatively predict sacral nerve stimulation responses.
authors.affiliation: Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Anna E R
authors.initials: AER
authors.lastname: Faris
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Gill
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Urogynecology Unit, Dr. Sotero del Rio Hospital, Santiago, Chile; Division de Obstetricia y Ginecologia, Pontificia Universidad Catolica de Chile, Santiago, Chile.
authors.forename: Javier
authors.initials: J
authors.lastname: Pizarro-Berdichevsky
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Elodi
authors.initials: E
authors.lastname: Dielubanza
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Clifton
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Henry
authors.initials: H
authors.lastname: Okafor
authors.affiliation: Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, Ohio; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
authors.affiliation: Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, Ohio; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Courtenay K
authors.initials: CK
authors.lastname: Moore
authors.affiliation: Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, Ohio; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Rackley
authors.affiliation: Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, Ohio; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: VasavaS@ccf.org.
authors.forename: Sandip P
authors.initials: SP
authors.lastname: Vasavada
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D020878:Device Removal; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014555:Urination Disorders / Q000150:complications / Q000628:therapy*
keywords: age groups; electric stimulation; overactive; prostheses and implants; urinary bladder