Predicting implantation with a neuromodulator using two different test stimulation techniques: A prospective randomized study in urge incontinent women

Aims The purpose of this study was to determine whether a percutaneous needle electrode (PNE) technique or a surgical first stage lead placement (FSLP) better predicted whether a patient would progress to implantation of a pulse generator (IPG) in older urge incontinent women. Methods Thirty subjects ≥55 years with refractory urge incontinence who had been selected to undergo a test stimulation procedure were randomized to either PNE or FSLP. Thirteen underwent PNE placement and seventeen underwent FSLP placement. If during the test stimulation period subjects had greater than 50% improvement in their incontinence parameters they qualified for permanent lead and/or IPG implantation of the Interstim® device. Results Twenty‐one subjects (70%) responded to the test stimulation and underwent implantation, 15/17 (88%) in the FSLP group and 6/13 (46%) in the PNE group. Subjects who were randomized to the FSLP group were significantly more likely to proceed to implantation of the IPG (P = 0.02) than those in the PNE group. There was no significant difference in demographics, pre‐test stimulation incontinence parameters or post‐stimulation visual analog pain scores between the randomized groups or between test stimulation responders and non‐responders. When comparing FSLP and PNE responders, there was no significant difference in the percent improvement in 24‐hr pad weight, daily pad usage, or daily incontinence. Conclusion FSLP better predicted progression to implantation of the IPG than a test stimulation with a PNE in an older urge incontinent cohort. Neurourol. Urodynam. © 2006 Wiley‐Liss, Inc.