Increasing Patient Preparedness for Sacral Neuromodulation Improves Patient-reported Outcomes Despite Leaving Objective Measures of Success Unchanged
Firoozi F, Gill B, Ingber MS, Moore CK, Rackley RR, Goldman HB, Vasavada SP. J Urol. 2013 Mar 13. pii: S0022-5347(13)03660-4. doi: 10.1016/j.juro.2013.03.025. [Epub ahead of print]


The Arthur Smith Institute for Urology, Center for Pelvic Health and Reconstructive Surgery, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York. Electronic address:



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.


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.


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.


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.