Does sex matter? A matched pairs analysis of neuromodulation outcomes in women and men
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To evaluate whether baseline symptoms and outcomes are influenced by gender in a matched cohort undergoing neuromodulation.
Patients in our prospective neuromodulation database that had a tined lead placed were reviewed. Those that had implantable pulse generator (IPG) placed were matched on age and urologic diagnosis. History, voiding diaries, satisfaction, Interstitial Cystitis Symptom/Problem Index (ICSIPI), and overactive bladder symptom severity (OABq ss)/health-related quality of life (HRQOL) preimplant and over 3 years were evaluated using descriptive statistics, repeated measures, and matched pair GEE or mixed analyses.
Of 590 patients in the database, more women than men received an IPG (450/488; 92.2 vs. 84/102; 82.4%; p = 0.0011). Eighty matched pairs (n = 160; 81% ≥ 50 years old; 56.25% had urgency/frequency with urge incontinence—UI) were identified and evaluated. On voiding diaries, volume/void was greater in women only at baseline (p = 0.040); both groups improved over time (p < 0.0001). Urinary frequency improved in both women and men (p = 0.0010; p = 0.0025). Over 3 years, UI episodes/day improved only in men (p = 0.017) and UI severity improved only in women (p < 0.0001). ICSIPI, OABq ss, and HRQOL scores improved similarly in both groups (p < 0.0001 for all measures in both groups), and although more women were satisfied at 3 months (p = 0.027), groups did not differ at other time points.
More women undergo neuromodulation and have initial success and subsequent IPG implantation. UI episodes improved only in men, and UI severity improved only in women. Both women and men experienced similar levels of symptom improvement on other measures.
KeywordsSacral neuromodulation Gender Patient outcome assessment Overactive bladder
This study was funded by a philanthropic grant from the Ministrelli Program for Urology Research and Education.
Compliance with ethical standards
Conflict of interest
Drs. Nguyen, Bartley, Gupta, Lavin, Khourdaji, Gilleran, and Gaines, Ms. Killinger and Ms. Boura declare that they have no conflicts of interest to disclose. Dr. Peters reports personal fees from Medtronic Inc., for whom he is a consultant and advisor; personal fees from StimGuard, for whom he is a consultant and in whom he has an investment interest; personal fees from Taris, Inc., for whom he is a consultant and advisor; and personal fees from Allergan, for whom he is a consultant and advisor.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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