Sacral neuromodulation in the golden years

Abstract

Introduction: Despite high prevalence and increased severity and burden of overactive bladder (OAB) and fecal incontinence (FI) in the elderly, sacral neuromodulation (SNM) is often overlooked as a potential treatment option for this demographic. In this study, we report the outcomes of SNM in patients aged 75 years or older at the time of surgery. Methods: We conducted a retrospective cohort study of patients who underwent SNM implantation between 2013 and 2022 performed by a single high-volume urologist at a tertiary center. Success, complication, and adjunct therapy rates were analyzed by Fisher’s or Wilcox rank-sum test as appropriate. We compared outcomes between patients aged 75–79 years and octogenarians. Results: Of 632 patients, 50 were 75 years. Patients had a mean age of 78.4±2.6 years and were predominantly female (84%). The indications for SNM were 66% OAB, 16% FI, 16% non-obstructive urinary retention, and 4% pelvic pain. Within the first year, 94% of patients reported satisfaction and improvement in symptoms, while 76% continued to experience improvement beyond one year. SNM insertion led to reduced oral medication use from 68% to 24% (p<0.0001). The complication rate was 16% and mostly included device pain. No significant difference was observed in treatment success, complication, or adjunct therapy rate between age groups. Conclusions: SNM is a safe and effective option in well-selected patients over the age of 75 years. Treatment success rate is comparable to younger cohorts. Advanced age should not preclude third-line therapy options in this population.