Anna Faris

Impact of Age and Comorbidities on Use of Sacral Neuromodulation

Purpose: We investigated the influence of patient age on sacral nerve stimulation trial outcomes, device implantation and treatment durability. Materials and Methods: 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. Results: 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). Conclusions: 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.

Perioperative Educational Interventions and Contemporary Sexual Function Outcomes of Radical Prostatectomy

INTRODUCTION Men undergoing prostatectomy can have unrealistic preoperative expectations regarding sexual function after surgery and may desire more education on recovery and symptom management. AIM To present contemporary data on recovery of sexual function after prostatectomy and characterize how it is impacted by perioperative patient educational interventions. METHODS A comprehensive review of the English-language literature available by PubMed search. MAIN OUTCOME MEASURES Rates of sexual function recovery after prostatectomy and the impact of educational interventions on these and related outcomes. RESULTS Available studies describe heterogeneous educational and support interventions that differ by patient selection, content, method of delivery, timing, and duration. Interventions with group-based education or peer support benefitted sexual satisfaction metrics. Many studies included men and their partners in supportive interventions. However, the few randomized controlled trials directly analyzing the effect of partner attendance revealed no additional benefit to outcomes. Interventions within 6 weeks of prostatectomy variably aided measures of sexual recovery. Some studies with greater time between prostate cancer treatment and interventions revealed only temporary improvements in outcomes. Yet durable improvements in sexual satisfaction and sexual function were observed in some men enrolled years after prostate cancer treatment. At times, web-based interventions had lower completion rates, but sexual function outcomes were comparable to traditional in-person interventions within randomized trials. CONCLUSION Educational interventions imparted variable benefit to sexual function and satisfaction, with group-based designs mostly benefitting satisfaction outcomes. Despite standardized interventions, men reported worse-than-expected outcomes, suggesting an emphasis on counseling regarding changes in erectile function at multiple time points before surgery and during the recovery period may be helpful. Earlier interventions may help with recovery by establishing more accurate patient expectations. Regarding accessibility, future endeavors may be improved with internet-based educational content, as such interventions appeared to provide comparable benefits to in-person sessions. Faris AER, Montague DK, Gill BC. Perioperative Educational Interventions and Contemporary Sexual Function Outcomes of Radical Prostatectomy. Sex Med Rev 2019;7:293-305.

Motor Response Matters: Optimizing Lead Placement Improves Sacral Neuromodulation Outcomes

Purpose: We sought to determine the usefulness of motor responses during sacral neuromodulation lead placement by testing the hypothesis that a greater number of motor responses during intraoperative electrode testing would be associated with more durable therapy. Materials and Methods: We retrospectively reviewed all sacral neuromodulation lead placements at a large academic center from 2010 to 2015. Included in study were all unilateral sacral lead placements for which the presence or absence of a motor response was documented discretely for each electrode. Motor responses were quantified into separate subscores, including bellows and toe response subscores (each range 0 to 4) for a possible maximum total score of 8 when combined. Revision surgery was the primary outcome. Univariate and multivariate analyses were performed for factors associated with lead revision. Results: A total of 176 lead placements qualified for analysis. Mean ± SD cohort age was 58.4 ± 15.9 years, 86.4% of the patients were female and 93.2% had undergone implantation for overactive bladder. Median followup was 10.5 months (range 2 to 36). Overall 34 patients (19%) required lead revision. Revision was negatively associated with the total electrode response score (p = 0.027) and the toe subscore (p = 0.033) but not with the bellows subscore (p = 0.183). Predictors of revision on logistic regression included age less than 59 years at implantation (OR 5.5, 95% CI 2–14) and a total electrode response score less than 4 (OR 4.2, 95% CI 1.4–12.8). Conclusions: Fewer total electrode responses and specifically fewer toe responses were associated with sacral neuromodulation lead revision. These data suggest that placing a lead with more toe responses during testing may result in more durable sacral neuromodulation therapy.

PD36-05 RATE AND RISK FACTORS FOR SACRAL NERVE STIMULATOR LEAD BREAKAGE AT THE TIME OF LEAD REVISION OR EXPLANTATION

Por: Pizarro-Berdichevsky, J (Pizarro-Berdichevsky, Javier)[ 1,2,3 ] ; Clifton, MM (Clifton, Marisa M.)[ 1 ] ;Dielubanza, EJ (Dielubanza, Elodi J.)[ 1 ] ; Gill, BC (Gill, Bradley C.)[ 1 ] ; Okafor, HT (Okafor, Henry T.)[ 1 ]; Faris, AE (Faris, Anna E.)[ 1 ] ; Rackley, RR (Rackley, Raymond R.)[ 1 ] ; Moore, CK (Moore, Courtenay K.)[ 1 ] ; Vasavada, SP (Vasavada, Sandip P.)[ 1 ] ; Goldman, HB (Goldman, Howard B.)[ 1 ] ...Más