Introduction and Aim

1. No. 060 An initial experience of sacral neuromodulation beyond 1 year follow-up: indications and outcomes Wilson Ailsa, Jenks Julie, HussainMahreen, Greenwell Tamsin, Shah Julian, HamidRizwan, Ockrim Jeremy University College London Hospitals, United Kingdom Introduction and Aim In urology sacral neuromodulation (SNM) is primarily indicated for urge incontinence (UI) and voiding dysfunction, but has also been utilised for sensory urgency and chronic pelvic pain syndromes. As a new and relatively expensive treatment it has undergone continuous scrutiny and audit to justify its role. The Functional and Reconstructive Urology unit at University College London Hospital (UCLH) is one of the largest referral centres in the UK and Europe for the performance of sacral neuromodulation, having offered it since 2008. Here we report an update of our outcomes, according to indication. Results • Methods • Prospective review from our database of all patients undergoing SNM procedures . Patients with a minimum of 6 months follow up were included. • Primary outcome assessment used pre and postoperative frequency-volume charts, pad testing, ICIQ/EQ5D questionnaires and pain scores. Success was considered as at least a 50% reduction in frequency-urgency or incontinent episodes, pad weight, symptom score or pain parameters, and in voiding dysfunction >50% reduction in need for CISC. Subjective success was considered to be a patient report of at least 50% improvement in urge/pain or quality of life. Results From September 2008 to May 2011 143 patients underwent PNE and of those 58 had a permanent SNS implanted. Mean age was 53.9 years (18-80) . 66% were female (n=95). One patient died from an unrelated cause prior to evaluation and so was excluded from analysis. Mean follow-up was 19 months (6-30). Results are described below. *one patient had a successful PNE but was deemed unsuitable for permanent implant due to learning difficulties **patient subsequently stated neither PNE nor SNS were helpful Closer analysis of those with DO revealed previous failed therapies predicted failure of SNM. Of the 44 patients with DO and no prior intervention, 61.3% (n=27) had a successful PNE. Of the 60 patients with DO and a prior intervention (intradetrusorbotulinum toxin-A or surgery), the conversion rate was 40% (n=24). Of those treated for DO the vast majority were idiopathic. The few with neurogenic DO had a lower success rate (20% vs 53%). Figs 3 and 4: Permanent implant (source fig 4 Medtronic) Conclusions In urge incontinence success rates were significantly higher in patients when SNM was used as initial therapy compared with those who had previous interventions. Use in voiding dysfunction produced the most predictable results, whereas the chance of success rates was substantially poorer for patients when used for pain syndromes, and with no benefit for patients with sensory urgency. Captions to be set in Arial font italic and no smaller than 6 points. Left aligned if it refers to a figure on its left. Caption starts right at the top edge of the picture (graph or photo). Figs 1 and 2: PNE (source fig 2 Medtronic) Poster presentation sponsor Acknowledgements