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Tilborghs S, De Wachter S. Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects. Expert Rev Med Devices 2022; 19:161-187. [DOI: 10.1080/17434440.2022.2032655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sam Tilborghs
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
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Ota HCU, Smith BG, Alamri A, Robertson FC, Marcus H, Hirst A, Broekman M, Hutchinson P, McCulloch P, Kolias A. The IDEAL framework in neurosurgery: a bibliometric analysis. Acta Neurochir (Wien) 2020; 162:2939-2947. [PMID: 32651707 PMCID: PMC7593304 DOI: 10.1007/s00701-020-04477-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Idea, Development, Exploration, Assessment and Long-term study (IDEAL) framework was created to provide a structured way for assessing and evaluating novel surgical techniques and devices. OBJECTIVES The aim of this paper was to investigate the utilization of the IDEAL framework within neurosurgery, and to identify factors influencing implementation. METHODS A bibliometric analysis of the 7 key IDEAL papers on Scopus, PubMed, Embase, Web of Science, and Google Scholar databases (2009-2019) was performed. A second journal-specific search then identified additional papers citing the IDEAL framework. Publications identified were screened by two independent reviewers to select neurosurgery-specific articles. RESULTS The citation search identified 1336 articles. The journal search identified another 16 articles. Following deduplication and review, 51 relevant articles remained; 14 primary papers (27%) and 37 secondary papers (73%). Of the primary papers, 5 (36%) papers applied the IDEAL framework to their research correctly; two were aligned to the pre-IDEAL stage, one to the Idea and Development stages, and two to the Exploration stage. Of the secondary papers, 21 (57%) explicitly discussed the IDEAL framework. Eighteen (86%) of these were supportive of implementing the framework, while one was not, and two were neutral. CONCLUSION The adoption of the IDEAL framework in neurosurgery has been slow, particularly for early-stage neurosurgical techniques and inventions. However, the largely positive reviews in secondary literature suggest potential for increased use that may be achieved with education and publicity.
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Affiliation(s)
| | - Brandon G Smith
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Faith C Robertson
- Department. of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hani Marcus
- The Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Allison Hirst
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Marike Broekman
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
- Department of Neurosurgery, Haaglanden Medical Center/Leiden University Medical Center, The Hague, Netherlands
| | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Peter McCulloch
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK.
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK.
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Benson K, McCrery R, Taylor C, Padron O, Blok B, de Wachter S, Pezzella A, Gruenenfelder J, Pakzad M, Perrouin-Verbe MA, Van Kerrebroeck P, Mangel J, Peters K, Kennelly M, Shapiro A, Lee U, Comiter C, Mueller M, Goldman H, Lane F. One-year outcomes of the ARTISAN-SNM study with the Axonics System for the treatment of urinary urgency incontinence. Neurourol Urodyn 2020; 39:1482-1488. [PMID: 32339339 PMCID: PMC7384085 DOI: 10.1002/nau.24376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022]
Abstract
Aims Sacral neuromodulation (SNM) is a guideline‐recommended treatment for voiding dysfunction including urgency, urge incontinence, and nonobstructive retention as well as fecal incontinence. The Axonics® System is a miniaturized, rechargeable SNM system designed to provide therapy for at least 15 years, which is expected to significantly reduce revision surgeries as it will not require replacement as frequently as the non‐rechargeable SNM system. The ARTISAN‐SNM study is a pivotal study designed to treat patients with urinary urgency incontinence (UUI). Clinical results at 1‐year are presented. Methods A total of 129 eligible UUI patients were treated. All participants were implanted with a quadripolar tined lead and neurostimulator in a single procedure. Efficacy data were collected using a 3‐day bladder diary, a validated quality of life questionnaire (ICIQ‐OABqol), and a participant satisfaction questionnaire. Therapy responders were defined as participants with ≥50% reduction in UUI episodes compared to baseline. Data were analyzed on all 129 participants. Results At 1 year, 89% of the participants were therapy responders. The average UUI episodes per day reduced from 5.6 ± 0.3 at baseline to 1.4 ± 0.2. Participants experienced an overall clinically meaningful improvement of 34 points on the ICIQ‐OABqol questionnaire. All study participants (100%) were able to recharge their device at 1 year, and 96% of participants reported that the frequency and duration of recharging was acceptable. There were no serious device‐related adverse events. Conclusions The Axonics System is safe and effective at 1 year, with 89% of participants experiencing clinically and statistically significant improvements in UUI symptoms.
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Affiliation(s)
| | - Rebecca McCrery
- Adult and Pediatric Urology and Urogynecology, Omaha, Nebraska
| | | | | | - Bertil Blok
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium
| | | | | | - Mahreen Pakzad
- Department of Urology, University College London Hospital, Marylebone, London, UK
| | | | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | - Andrew Shapiro
- Chesapeake Urology Research Associates, Owings Mills, Maryland
| | - Una Lee
- Virginia Mason, Seattle, Washington
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Mehta SH, Hoelscher CM, Sharan AD, Thalheimer S, Wu C. Implantable Pulse Generator Site May Be Associated With Spinal Cord Stimulation Revision Surgeries. Neuromodulation 2019; 24:1336-1340. [PMID: 31215711 DOI: 10.1111/ner.12976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/06/2019] [Accepted: 05/01/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The use of implantable pulse generators (IPG) for spinal cord stimulation (SCS) in patients with chronic pain has been well established. Although IPG-related complications have been reported on, the association between IPG site and SCS complications has not been well studied. OBJECTIVE To investigate whether IPG placement site in buttock or flank is associated with SCS complications and, hence, revision surgeries. METHOD A retrospective cohort study was performed that included 330 patients (52% female) treated at a single institution who underwent permanent implantation of an SCS system between 2014 and 2018. Patients ranged between 20 and 94 years of age (mean: 57.54 ± 13.25). Statistical analyses were conducted using IBM SPSS Statistics. Tests included independent samples t test, chi-square test, Mann-Whitney U test, Spearman's rank correlation coefficient, and logistic regression. RESULTS There was a total of 93 revision surgeries (rate of 28%), where 71 out of 330 patients (rate of 21.5%) had had at least one revision surgery. Univariate tests demonstrated a significant association between IPG site and revision surgeries (p = 0.028 [chi-square test] and p = 0.031 [Mann-Whitney U test]); however, multivariate logistic regression demonstrated that neither IPG site was more likely than the other to require revision surgeries (p = 0.286). CONCLUSION Although this study found a significant association between IPG site and revision surgeries, the effect of IPG site was not found to be predictive. The IPG site likely influences whether a patient will require revision surgery, but further investigation is required to establish this association.
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Affiliation(s)
- Shyle H Mehta
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christian M Hoelscher
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sara Thalheimer
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Blok B, Van Kerrebroeck P, de Wachter S, Ruffion A, Van der Aa F, Jairam R, Perrouin‐Verbe MA, Elneil S. A prospective, multicenter study of a novel, miniaturized rechargeable sacral neuromodulation system: 12‐month results from the RELAX‐OAB study. Neurourol Urodyn 2018; 38:689-695. [DOI: 10.1002/nau.23892] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/29/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Bertil Blok
- Department of UrologyErasmus MCRotterdamThe Netherlands
| | | | | | - Alain Ruffion
- Department of UrologyHôpital Lyon SudPierre BéniteLyonFrance
| | | | - Ranjana Jairam
- Department of UrologyMaastricht University Medical CentreMaastrichtThe Netherlands
| | | | - Sohier Elneil
- Department of Uro‐NeurologyNational Hospital of Neurology and NeurosurgeryLondonUnited Kingdom
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Blok B, Van Kerrebroeck P, de Wachter S, Ruffion A, Van der Aa F, Jairam R, Perrouin-Verbe M, Elneil S. Programming settings and recharge interval in a prospective study of a rechargeable sacral neuromodulation system for the treatment of overactive bladder. Neurourol Urodyn 2018; 37:S17-S22. [PMID: 29336058 DOI: 10.1002/nau.23476] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 11/29/2017] [Indexed: 01/17/2023]
Abstract
AIMS The RELAX-OAB study is designed to confirm the safety, efficacy, and technical performance of the Axonics r-SNM System, a miniaturized, rechargeable SNM system approved in Europe and Canada for the treatment of bladder and bowel dysfunction. The purpose of this article is to describe study subjects' ability to charge the rechargeable neurostimulator and to document their neurostimulator program settings and recharge interval over time. METHODS Fifty-one OAB patients were implanted in a single-stage procedure. These results represent the 3-month charging experience for 48 subjects who completed the 3-month follow-up. Recharge intervals were estimated using therapy stimulation settings and subject experience was evaluated using questionnaires. RESULTS Forty-seven of forty-eight (98%) subjects were able to successfully charge their device prior to follow-up within 1-month post-implant. At 3-month post-implant, 98% of subjects were able to charge prior to their follow-up visit. Average stimulation amplitude across all subjects was 1.8 mA (±1.1 mA). A total of 69% of subjects had ≥14-day recharge intervals (time between charging) and 98% of subjects had ≥7-day recharge interval. No charging related adverse events occurred. CONCLUSIONS Study subjects were able to charge the Axonics r-SNM System and stimulation settings provided 2 weeks of therapy between recharging for most subjects. Subject satisfaction indicates that subjects are satisfied with rechargeable SNM therapy.
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Affiliation(s)
- Bertil Blok
- Department of Urology, Erasmus M, edical Center, Rotterdam, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium
| | - Alain Ruffion
- Department of Urology, Hôpital Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Ranjana Jairam
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sohier Elneil
- Department of Uro-Neurology, National Hospital of Neurology and Neurosurgery, London, United Kingdom
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Blok B, Van Kerrebroeck P, de Wachter S, Ruffion A, Van der Aa F, Jairam R, Perrouin-Verbe M, Elneil S. Three month clinical results with a rechargeable sacral neuromodulation system for the treatment of overactive bladder. Neurourol Urodyn 2018; 37:S9-S16. [PMID: 29315785 DOI: 10.1002/nau.23465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/03/2017] [Indexed: 12/18/2022]
Abstract
AIMS The primary aim of the RELAX-OAB study is to confirm the safety and efficacy of the Axonics r-SNM System, a miniaturized, rechargeable SNM system. METHODS A total of 51 OAB patients were implanted in a single-stage implant procedure. These results represent the 3-month outcomes. Subject outcomes were evaluated using 3-day bladder diaries and quality of life questionnaires. RESULTS A total of 31 of 34 patients (91%) that responded during an initial trial period ("Test Responders") continued to benefit from therapy with the Axonics r-SNM System at 3-months, defined as symptom improvement of ≥50% reduction in urinary voids or incontinence episodes or a return to <8 voids per day. Subjects who were Test Responders showed a statistically and clinically meaningful improvement in all aspects of quality of life (ICIQ-OABqol). No serious device-related adverse events (SADEs) occurred, and there were no unanticipated adverse events (UAEs). One subject was explanted due to an infection at the implant site and 19.6% of subjects experienced device related adverse events, most notably discomfort due to stimulation, which was resolved with reprogramming. CONCLUSIONS The Axonics r-SNM System provides safe and effective SNM therapy with objective improvement in 91% of subjects. The data also demonstrates a significant improvement in all domains of quality of life. This miniaturized, rechargeable system is designed to last 15 or more years and is expected to provide clinical and cost benefits over current non-rechargeable systems by eliminating replacement surgeries.
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Affiliation(s)
- Bertil Blok
- Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium
| | - Alain Ruffion
- Department of Urology, Hôpital Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Ranjana Jairam
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sohier Elneil
- Department of Uro-Neurology, National Hospital of Neurology and Neurosurgery, London, United Kingdom
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Cohn JA, Kowalik CG, Kaufman MR, Reynolds WS, Milam DF, Dmochowski RR. Evaluation of the axonics modulation technologies sacral neuromodulation system for the treatment of urinary and fecal dysfunction. Expert Rev Med Devices 2016; 14:3-14. [PMID: 27915486 DOI: 10.1080/17434440.2017.1268913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) remains one of the few effective treatments for refractory bladder and bowel dysfunction. However, SNM is associated with frequent need for surgical intervention, in many cases because of a failed battery. A rechargeable SNM system, with a manufacturer-reported battery life of 15 years or more, has entered post-market clinical testing in Europe but has not yet been approved for clinical testing in the United States. Areas covered: We review existing neuromodulation technologies for the treatment of lower urinary tract and bowel dysfunction and explore the limitations of available technology. In addition, we discuss implantation technique and device specifications and programming of the rechargeable SNM system in detail. Lastly, we present existing evidence for the use of SNM in bladder and bowel dysfunction and evaluate the anticipated trajectory of neuromodulation technologies over the next five years. Expert commentary: A rechargeable system for SNM is a welcome technological advance. However surgical revision not related to battery changes is not uncommon. Therefore, while a rechargeable system would be expected to reduce costs, it will not eliminate the ongoing maintenance associated with neuromodulation. No matter the apparent benefits, all new technologies require extensive post-market monitoring to ensure safety and efficacy.
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Affiliation(s)
- Joshua A Cohn
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Casey G Kowalik
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Melissa R Kaufman
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - W Stuart Reynolds
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Douglas F Milam
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Roger R Dmochowski
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
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Noblett KL, Dmochowski RR, Vasavada SP, Garner AM, Liu S, Pietzsch JB. Cost profiles and budget impact of rechargeable versus non-rechargeable sacral neuromodulation devices in the treatment of overactive bladder syndrome. Neurourol Urodyn 2016; 36:727-733. [DOI: 10.1002/nau.23008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/04/2016] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | | | - Shan Liu
- Wing Tech, Inc.; Menlo Park California
- University of Washington; Seattle Washington
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