Impact of Age on Trial of Sacral Neuromodulation

Objectives: Sacral neuromodulation (SNM) is a surgical treatment for refractory urinary urgency, frequency, non-obstructive retention, and fecal incontinence. The objective of this study was to investigate the influence of age on progression from stage 1 (trial) to stage 2 (implantation) for patients with overactive bladder.

Methods: This was a retrospective chart review spanning three years. Patients were included if they underwent SNM for overactive bladder. Statistical analysis was performed using SAS version 9.4 to analyze patients progressing from trial stage to implantation based on age cohort. Patients were stratified into cohorts by decade of age. The decision to progress from stage 1 to stage 2 was based on at least a 50% reduction in presenting symptoms.

Results: The average age of the sample was 67 years old. Most patients were white (79%), with an average BMI of 29 kg/m2. The highest rates of progression from stage 1 to stage 2 were seen above age 50, with each decade over 50 having at least an 82% success rate (see Table 1: Age cohorts by decade). There were few failures overall (17%), and they were distributed throughout all age groups (p=0.83).

Conclusions: In our study population, there was no significant correlation between age and progression from stage 1 to stage 2 for those undergoing SNM. Also, most participants were in at least their 6th decade of life, showing that this procedure is generally performed in older women. A limitation to our study is the small sample size; it cannot be extrapolated to the general population as this study was conducted at a single institution. Further studies should focus on comorbid health conditions, which plausibly have a greater impact than age on the success of SNM. Our data ultimately shows that older patients should not be precluded from this surgical intervention since they have similar success rates to their younger counterparts.