Increasing Patient Preparedness for Sacral Neuromodulation Improves Patient-reported Outcomes Despite Leaving Objective Measures of Success Unchanged

Abstract

Introduction

We assessed how a GSA influenced patient preparedness for, as well as both subjective and objective outcomes of SNS for refractory overactive bladder and/or urge urinary incontinence.

Methods

Patients considering SNS were prospectively enrolled and invited to attend a GSA, which was a 75 minute presentation, including question and answer period with an implanting surgeon and an implanted patient. Control patients were those who received standard office counseling. The patient preparedness questionnaire was completed after the GSA or office counseling. The Postoperative Satisfaction Questionnaire and PGI-I, as well as voiding diaries, gauged response to treatment.

Results

36 women received SNS in our study. Their mean(SD) age was 61(15) years, with no significant differences in patient demographics between the GSA (N=19) and non–GSA (N=17) groups. Overall preparedness (p=0.043) was greater in the GSA group, with better understanding of the purpose (p=0.003) and alternatives (p=0.043) to SNS. Significantly more women in the GSA than non–GSA group felt completely prepared (78.9% vs 29.4%, p=0.003) and completely satisfied (78.9% vs 35.3%, p=0.003) with SNS as well as "very much better" (68.4% vs 17.6%, p=0.002) according to the PGI–I instrument. There were no differences between groups in the number of women with a 50% or greater symptom reduction per voiding diary.

Conclusion

Participating in a GSA prior to SNS improved patient preparedness and perceived outcomes of the treatment despite no difference in objective outcomes based on voiding diary.