(Poster 161) Rate of SNM Explantation in Patients with CNS Pathology and OAB

Objectives: Assess the rate of sacral neuromodulation (SNM) explantation in patients with CNS pathology compared to baseline controls.

Methods: This is a retrospective cohort study utilizing the TriNetX Research Network platform using years 2010 to 2025. TriNetX is a global federated network of electronic medical record data from 95 health care organizations and provides a de-identified EMR database for up to 128 million patients. Adult (18 years or older) female patients were included in the study if they had overactive bladder (ICD-10 code N32.81), urge incontinence (ICD-10 code N39.41), or urgency of urination (R39.15) and had sacral neurostimulator insertion (CPT code 64590) from 2010 to 2025. We excluded patients that had the device removed for surgical site infection (ICD T85.79) or pain due to the implant (T83.84XA. We then developed five cohorts for multiple sclerosis, dementia, Parkinson’s disease, stroke, and normal pressure hydrocephalus (NPH). Diagnoses for the cohorts utilized the ICD codes G35.XXX, F01.XXX, F03.XXX, G30.XXX, G20.XXX, I61.XXX, I63.XXX, and G91.2 (respectively). Additionally, we included patients with medications used for dementia; Rivastigmine, Galantamine, Donepezil, and Memantine. We included patient using Levodopa in our Parkinson’s cohort. The baseline cohort did not have the above cohort diagnoses. The primary outcome was the rate of neurostimulator device revision or removal (CPT 64595) within 5 years.

Results: There was a significant difference in the rates of SNM explantation in patients with a history of stroke 49/529 (9.26%) in comparison to the control group 1091/8633 (12.64%) (p < 0.05). There was no significant difference between the rate of explantation for the Parkinson’s disease group 32/328 (9.76%), dementia group 52/487 (10.68%) and the MS group 58/462 (12.55%) in comparison to the control group. The Kaplan Meier curves for each cohort are shown in figure 1.

Conclusions: Our study suggests that patients with a history of stroke have a lower rate of SNM explantation compared to our control group. Additionally, our findings suggest that there is no difference in the rate of explantation for patients with dementia, Parkinson’s disease, or multiple sclerosis. A strength of our study is the large number of subjects from a wide variety of medical centers and surgeons. Additionally, by excluding patients with a surgical site infection or implant pain we limited the effect that removal for infectious or pain etiologies impacted our study results. The study is limited by the administrative nature of the database and the retrospective nature of the study. This limits our ability to definitively state the indication for device removal.