Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice

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.


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.



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