Society of Urodynamics, Female Pelvic
Medicine & Urogenital Reconstruction

Abstract Aims To evaluate the long‐term outcomes of sacral neuromodulation (SNM), and patient characteristics that may predict long‐term success or complications. Methods A single‐center retrospective cohort study was performed of all patients who underwent SNM testing and implantation. Outcome results, resolution of symptoms, and device removal were reported. Multivariable logistic regression was used to identify predictors of success. Cox proportional hazards model was used to identify predictors for device removal. Results Four hundred and thrity four patients underwent SNM test phase of which 241 (median age 48.0 years, 91.7% [221/241] female) had device implantation and were followed up for median [range] time of 4.0 (3 months–20.5 years) years. Multivariable logistic regression showed that male gender (odds ratio: 0.314; 95% confidence interval: 0.164–0.601, p = .0005) was independently associated with decreased peripheral nerve evaluation success. At final follow‐up for patients who originally had device implantation, median (interquartile range) percent of symptoms resolution of all patients was 60.0% (0%–90%) and 69.3% (167/241) had SNM successful outcomes. Cox proportional hazards model showed no difference for time to SNM device removal with respect to patient age, gender, or diagnosis. 69.3% (167/241) patients had at least 1 surgical re‐intervention. The most common reason at first surgical re‐intervention was lead change only (26.3%, 44/167). Conclusion SNM is a minimally invasive procedure with good long‐term success rates. There is a high revision rate but overall, SNM has a good safety profile and excellent long‐term outcomes.

Abstract Objective The aim of this study was to evaluate the correlation between pre‐existing conditions and worsening of Stage I untreated posterior vaginal wall prolapse (PVWP) after vaginal hysterectomy and anterior repair at 12‐month follow‐up. Methods This is a multicenter retrospective study. Women with symptomatic (vaginal bulging and low back pain) anterior and/or apical pelvic organ prolapse (POP) and I stage PVWP were enrolled. Patients were submitted to vaginal hysterectomy and native‐tissue anterior vaginal wall repair. Risk factors for POP development were collected for each woman before surgery. At 12 month‐follow‐up after surgery, women were evaluated and divided into two groups depending on the anatomical finding of the posterior vaginal wall according to the Pelvic Organ Prolapse Quantification System: women with Persistent I stage PVWP and patients with worsened PVWP more than or equal to II stage. Difference of distribution of risk factors for POP between the two groups was evaluated. Correlation between risk factors and development of PVWP more than I stage was assessed. Results Seventy women were submitted to POP surgery. Significant difference in constipation before surgery and degree of anterior and central vaginal compartments descent was observed (p < .01) between the two groups. Constipation before surgery resulted as an independent factor in worsening of PVWP at 12‐month follow‐up (p value = .01; odds ratio 1.99 [1.49–2.33]). Conclusion Untreated Stage I PVWP, not included in the first surgical repair, can significantly get worse in women complaining of constipation at 12‐month follow‐up.