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Optimization of Sacral Neuromodulation Therapy: Clinical Outcomes and Patient Suitability Exploration of Variable Frequency Mode: A prospective multi-center study

L. Meng¹, Q. Wang², B. Shi³, Z. Wei⁴, W. Song⁵, Y. Niu⁶, X. Tian⁷, Y. Zhang¹

¹Beijing Hospital, urology, Beijing, China
²the First Affiliated Hospital of Zhengzhou University, urology, Zhengzhou, China
³Qilu hospital of Shandong University, urology, Jinan, China
⁴The Second Affiliated Hospital of Nanjing Medical University, urology, Nanjing, China
⁵Shandong Provincial Hospital, urology, Jinan, China
⁶The Second Hospital of Tianjin Medical University, urology, Tianjin, China
⁷Peking University Third Hospital, urology, Beijing, China

Introduction:

The aim of this study was to optimize sacral neuromodulation (SNM) therapy by evaluating the clinical outcomes of the variable-frequency (VF) mode and to explore the suitability of this mode for different patient populations with lower urinary tract symptoms (LUTS).

Material and methods:

A prospective clinical trial was conducted involving 55 patients with LUTS, who were randomized to receive either constant frequency (CF) or VF SNM treatment over a 12-week period. The efficacy of both modes was assessed using a comprehensive set of indicators, including Quality of Life (QoL), Visual Analogue Scale (VAS), and Overactive Bladder Symptom Score (OABSS). Logistic regression analysis was employed to identify patient characteristics that are predictive of better outcomes with the VF mode. A nomogram web tool was developed to assist clinicians in selecting the most appropriate SNM frequency mode for individual patients.

Results:

The VF mode showed superior improvement rates across most monitored parameters compared to the CF mode. However, logistic regression revealed counterintuitive findings: patients with higher BMI, more comorbidities, more LUTS-related symptoms, or a diagnosis of Neurogenic Lower Urinary Tract Dysfunction (NLUTD) were less likely to benefit from the VF mode. The developed nomogram web tool demonstrated good discriminative ability with an area under the receiver operating characteristic curve (AUC) of 0.833 for both training and validation groups.