Sacral Neuromodulation Revision Has a Low Infection Rate

Objectives: Sacral neuromodulation (SNM) is indicated for the treatment of overactive bladder, urinary retention, urinary frequency, fecal incontinence. The surgical site infection rate for initial implantation is 4-10%. There is a 30% rate of revision or explanation of the device. Our primary outcome was to establish the surgical site infection rate for SNM revision. Secondarily, we examined surgical site infection rate based on using the same site for battery pocket versus creating a new battery pocket on the contralateral side.

Methods: Subjects between the ages of 18-80 who underwent replacement of sacral neuromodulation device between March 1, 2018 and November 30, 2023 were included. The electronic medical record was abstracted for data on clinical characteristics, peri-operative antibiotic use, and post-operative surgical site infection. Our primary outcome was the surgical site infection rate. Our secondary outcome was surgical site infection rate based on pocket site and differences in clinical characteristics. These outcomes were evaluated using Fisher’s exact test.

Results: There were 169 patients included in the analysis. The median time from initial implantation to the first revision procedure was 57 months. The most common indications for revision included: depleted battery (52%), ineffective response (33%), lead migration (13%), battery site pain (10%). Surgical site infections occurred in 9 patients (5%). The same site for battery pocket was utilized in 130 subjects and a new battery pocket on the contralateral side was used in 38 subjects. There was no difference in infection rate based on use of the same site for battery pocket compared to a new site (Table 1). There was no association of surgical site infection with lead and battery removal compared to battery removal alone, smoking status, or BMI. The majority of subjects were prescribed oral antibiotic prophylaxis post-operatively (73%) with a duration between 2-14 days. Twenty-seven percent of patients were not discharged with oral antibiotics, and there were no infections in this group. Of the patients discharged with antibiotics, there were less infections in those discharged with trimethoprim-sulfamethoxazole than cephalexin however this was not statistically significant.

Conclusions: In conclusion, the surgical site infection rate with SNM revision is similar to the infection rate for initial implantation. There was no difference in infection rate using a new pocket for SNM revision compared to using the old pocket. The use of post-operative prophylactic antibiotics was not associated with a decreased rate of surgical site infection.