Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;23(8):1121-1129.
doi: 10.1111/ner.13117. Epub 2020 Mar 9.

Programming Algorithms for Sacral Neuromodulation: Clinical Practice and Evidence-Recommendations for Day-to-Day Practice

Paul A Lehur  1 , Michael Sørensen  2 , Thomas C Dudding  3 , Charles H Knowles  4 , Stefan de Wachter  5   6 , Stefan Engelberg  7 , Klaus E Matzel  8 ; European SNM Expert Group
Affiliations

Programming Algorithms for Sacral Neuromodulation: Clinical Practice and Evidence-Recommendations for Day-to-Day Practice

Paul A Lehur et al. Neuromodulation. 2020 Dec.

Abstract

Background: In sacral neuromodulation (SNM), stimulation programming plays a key role to achieve success of the therapy. However to date, little attention has been given to the best ways to set and optimize SNM programming during the test and chronic stimulation phases of the procedure.

Objective: Standardize and make SNM programming easier and more efficient for the several conditions for which SNM is proposed.

Methods: Systematic literature review and collective clinical experience report.

Results: The basic principles of SNM programming are described. It covers choice of electrode configuration, stimulation amplitude, pulse frequency and pulse widths, while use of cycling is also briefly discussed. Step-by-step practical flow charts developed by a group of 13 European experts are presented.

Conclusions: Programming of SNM therapy is not complex. There are few programming settings that seem beneficial or significantly impact patient outcomes. Only four basic electrode configurations could be identified according to four different options to define the cathode. In a majority of patients, the proposed stimulation parameters will allow a satisfactory improvement for long periods of time. A regular follow-up is, however, necessary to assess and eventually optimize results, as well as to reassure patients.

Keywords: Basic programming; electric stimulation; fecal incontinence; pelvic organ dysfunction; sacral neuromodulation; urinary incontinence.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Prisma flow diagram—systematic review of the literature on SNM programming. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Recording document for SNM therapy. Reproduced with permission from Reference 7. [Color figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Programming at the test phase—staged tined‐lead procedure (first SNM stage). [Color figure can be viewed at wileyonlinelibrary.com]
Figure 4
Figure 4
Initial (first) programming following IPG implantation (second SNM stage). [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. Matzel KE, Chartier‐Kastler E, Knowles CH et al. Sacral neuromodulation: standardized electrode placement technique. Neuromodulation 2017;20:816–824. - PubMed
    1. Hobson DTG, Gaskins JT, Frazier L, Francis SL, Kinman CL, Meriwether KV. Current practice patterns and knowledge among gynecologic surgeons of InterStim® programming after implantation. Int Urogynecol J 2018;29:1135–1140. - PubMed
    1. Moher D, Shamseer L, Clarke M et al. Preferred reporting items for systematic review and meta‐analysis protocols (PRISMA‐P) 2015 statement. Syst Rev 2015;4:1 10.1186/2046-4053-4-1. - DOI - PMC - PubMed
    1. Van Kerrebroeck PE, Marcelissen TA. Sacral neuromodulation for lower urinary tract dysfunction. World J Urol 2012;30:445–450. - PubMed
    1. Dudding TC, Hollingshead JR, Nicholls RJ, Vaizey CJ. Sacral nerve stimulation for faecal incontinence: optimizing outcome and managing complications. Colorectal Dis 2011;13:e196–e202. - PubMed

Publication types

Grants and funding