NEW ORLEANS, LA USA (UroToday.com) - One of the clinical research prize abstract finalists studied the feasibility and outcomes of a single stage versus two-stage procedure for implantation of a sacral neurostimulation device (InterStim II®, Medtronic, Minneapolis, MN). The authors retrospectively reviewed a prospective database of consecutive patients undergoing device implantation but excluded patients with neurogenic bladders.
Thirty-three patients underwent a single-stage procedure and 98 had a 2-stage operation for a total of 131 patients. Both groups underwent surgery at a median age of 9 years. The authors reported that 98% of the patients that underwent a staged procedure went on to have the second stage (meaning, the majority of patients were satisfied with the initial phase results such that they went on to complete the implantation). Both groups had similar rates of subjective improvement in their incontinence, constipation, and urinary frequency/urgency. Revision rates were 24% and 34% for the single and 2-stage operations (p=NS), respectively, and explantation rates were 0 and 4. Total anesthesia time was decreased for the patients undergoing a single stage procedure (92 vs 157 min).
Most of the commentary on this abstract was concerned with poor insurance reimbursement if the surgery is performed in only one stage. Audience members reported that any effort to implant a neuromodulator in one stage would be rejected by insurance companies, despite the obvious savings of avoiding one trip to the operating room. The authors responded that, hopefully, with increasing concerns about anesthesia neurotoxicity and the publication of this data presented today, insurance companies will ultimately capitulate to this option.
Presented by Andrew McCall at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Minneapolis, MN USA
Reported by Michaella M. Prasad, MD (Medical University of South Carolina, Charleston, SC USA), medical writer for UroToday.com