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Article of the week: Prolonged SNM testing effective despite bacteria presence

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

If you only have time to read one article this week, it should be this one.

Prolonged percutaneous SNM testing does not cause infection-related explanation

Bastian Amend, Jens Bedke, Mahmoud Khalil, Arnulf Stenzl and Karl-Dietrich Sievert

Department of Urology, Eberhard Karls University Tuebingen, Tuebingen, Germany

OBJECTIVE

• To evaluate the impact of prolonged stage 1 testing on bacterial electrode colonization, infection and treatment success.

MATERIALS AND METHODS

• In all, 21 patients who underwent sacral neuromodulation (SNM) for periods 1 month were prospectively evaluated; nine patients had overactive bladder syndrome (OAB), 10 had urinary retention, two had faecal incontinence (FI), and 13 had diabetes and overweight/obesity.

• After stage 1 testing electrode extension leads were microbiologically analysed to assess bacterial colonization.

• The primary measurements were pre- and post-SNM treatment comparisons based on patient-agreed criteria using an increased 70% minimum improvement rate; secondary measurements were bacterial colonization and impact of infection.

RESULTS

• The mean stage 1 evaluation period was 52.3 days; 16 patients (76%) progressed to stage 2, and five patients were explanted due to inadequate improvement (<70%).

• There was bacterial colonization in 42.9% of patients and 38.2% of extension leads.

• Stage 2 patients showed no infection or wound-healing disorders at a mean follow-up of 33.9 months.

• The success rate for stage 2 implantation treatment was 94%.

CONCLUSIONS

• There are few studies in the literature evaluating SNM testing periods vs the risk of clinically relevant implant infection rates. The present study shows that prolonged testing could potentially enhance treatment efficacy without infection-related explantations of the chronic implant, despite the identification of bacteria.

• SNM-implanted patients with diabetes mellitus or obesity should be followed closely.

• Clinicians might consider using prolonged testing under everyday conditions.

• Prolonged SNM stage 1 testing is a very effective minimally invasive treatment option to evaluate pelvic-related dysfunction.

 

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