Open AccessReprogramming Sacral Neuromodulation for Sub‐Optimal Outcomes: Evidence and Recommendations for Clinical Practice
Author(s) -
Dudding Thomas C.,
Lehur Paul A.,
Sørensen Michael,
Engelberg Stefan,
Bertapelle Maria Paola,
ChartierKastler Emmanuel,
Everaert Karel,
Van Kerrebroeck Philip,
Knowles Charles H.,
Lundby Lilli,
Matzel Klaus E.,
MuñozDuyos Arantxa,
Rydningen Mona B.,
Wachter Stefan
Publication year - 2021
Publication title -
neuromodulation: technology at the neural interface
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.296
H-Index - 60
eISSN - 1525-1403
pISSN - 1094-7159
DOI - 10.1111/ner.13494
Subject(s) - reprogramming , sacral nerve stimulation , medicine , neuromodulation , adverse effect , troubleshooting , intensive care medicine , usability , physical medicine and rehabilitation , physical therapy , computer science , surgery , stimulation , reliability engineering , engineering , human–computer interaction , genetics , cell , biology
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.