“How Long Until I Can Shower?”: Time from PNE Placement to Symptom Reduction

Objectives: To describe time to >/=50% reduction of bothersome urinary symptoms after percutaneous nerve evaluation (PNE). Secondary objective was to report the diagnostic accuracy of a 3-day PNE trial.

Methods: Retrospective study of patients who underwent PNE for bothersome urinary frequency, urgency, and/or urge urinary incontinence March 2022-March 2024. Patients were excluded if the indication for PNE was fecal incontinence or non-obstructive urinary retention alone, if pre- and post-procedure bladder diary data was incomplete, and/or if they never achieved >/=50% symptom reduction. Patients were identified using Current Procedural Terminology codes, with clinical and demographic data obtained through chart review. The primary outcome was time from PNE placement (trial day 0) to >/= 50% decrease in daily frequency, urgency or urge incontinence as determined by comparison of pre- and post-procedure bladder diary. Descriptive statistics and diagnostic accuracy testing was performed. A Kaplan-Meier model was developed to plot a survival curve. Sample size calculation utilized a non-parametric Brookmeyer-Crowley approach with 1 sided alpha=0.05, and 42 events were required for 90% power. Post-hoc power calculation revealed >80% power with 41 events.

Results: Forty-one patients, who were predominantly non-Hispanic white (34/41, 82.9%), had a mean age of 58.5 +/- 12 years and had a median BMI 33 (IQR 26.5-38.0), met inclusion criteria. Median trial duration was 4 days (range 1-7), and all patients had bilateral PNE leads placed. By trial day 2, 75% of women achieved >/=50% symptom reduction (95% CI, 1-3 days; Figure 1), with 90% achieving this by the end of trial day 3. The sensitivity of a 3-day PNE trial was 92.7% (95% CI, 85.3-100). Negative predictive value of a 3-day PNE trial in this population was 70.0% (95% CI, 57.0-83.0).

Conclusions: It is possible that PNE trials less than 7 days have acceptable diagnostic accuracy. The comparative diagnostic accuracies of PNE trials less than one week should be further explored in representative populations.