Neuromodulation. 2021 Jul 15. doi: 10.1111/ner.13494. Online ahead of print.

Thomas C Dudding ¹, Paul A Lehur ², Michael Sørensen ³, Stefan Engelberg ⁴, Maria Paola Bertapelle ⁵, Emmanuel Chartier-Kastler ⁶, Karel Everaert ⁷, Philip Van Kerrebroeck ⁸, Charles H Knowles ⁹, Lilli Lundby ¹⁰, Klaus E Matzel ¹¹, Arantxa Muñoz-Duyos ¹², Mona B Rydningen ¹³, Stefan de Wachter ¹⁴

Author information

• ¹Pelvic Floor Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
• ²Coloproctology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland.
• ³Department of Surgical and Medical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
• ⁴Medtronic Intl Sarl, Tolochenaz, Switzerland.
• ⁵Neurourology Maria Adelaide Hospital, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy.
• ⁶Department of Urology, Sorbonne Université, Academic Hospital Pitié-Salpétrière, Paris, France.
• ⁷Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium.
• ⁸Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
• ⁹Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London & Barts Health NHS Trust, London, UK.
• ¹⁰Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
• ¹¹Chirurgische Klinik, Sektion Koloproktologie, Universität Erlangen, Erlangen, Germany.
• ¹²Coloproctology Unit, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Spain.
• ¹³Norwegian National Advisory Unit on Incontinence and Pelvic Floor Health, University Hospital of North Norway, Tromso, Norway.
• ¹⁴Department of Urology, Faculty of Health Sciences, University Hospital Antwerpen, University Antwerpen, Edegem, Belgium.

Abstract

Objectives: In some patients treated for urinary or fecal incontinence with sacral neuromodulation (SNM) persistence of symptoms, a reduction in efficacy or adverse effects of stimulation can occur. In such situations, further programming of the SNM device can help resolve problems. Infrequently hardware failure is detected. This article aims to provide practical guidance to solve sub-optimal outcomes (troubleshooting) occurring in the course of SNM therapy.

Materials and methods: A systematic literature review was performed. Collective clinical experience from an expert multidisciplinary group was used to form opinion where evidence was lacking.

Results: Circumstances in which reprogramming is required are described. Actions to undertake include changes of electrode configuration, stimulation amplitude, pulse frequency, and pulse width. Guidance in case of loss of efficacy and adverse effects of stimulation, developed by a group of European experts, is presented. In addition, various hardware failure scenarios and their management are described.

Conclusions: Reprogramming aims to further improve patient symptoms or ensure a comfortable delivery of the therapy. Initial changes of electrode configuration and adjustment of stimulation parameters can be performed at home to avoid unnecessary hospital visits. A logical and stepwise approach to reprogramming can improve the outcome of therapy and restore patient satisfaction.