Do you really want to deactivate your sacral neuromodulation device during pregnancy? A single center case series
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ORIGINAL ARTICLE
Do you really want to deactivate your sacral neuromodulation device during pregnancy? A single center case series Marco Agnello 1
&
Mario Vottero 2 & Paola Bertapelle 2
Received: 1 September 2020 / Accepted: 26 October 2020 # The Author(s) 2020
Abstract Introduction and hypothesis The main objective of the study is to assess the efficacy and safety of sacral neuromodulation (SNM) during pregnancy. Methods We retrospectively enrolled patients who underwent SNM implantation in our center and subsequently became pregnant. The indication for SNM, timing of device de-activation (if performed), course of pregnancy and urological complications, duration of labor, childbirth term, delivery mode, congenital abnormalities and SNM dysfunctions after delivery were recorded. Results Fourteen pregnancies were recorded among 11 women undergoing SNM. Indications for device implantation were urinary retention (7 cases) and dysfunctional voiding (4 cases). Two patients carried on two and three pregnancies, respectively, with the device turned off since the first trimester. They both had to return to self-catheterization and developed recurring urinary tract infections. No major urological complications were recorded among the remaining nine women that kept the device on during pregnancy. A cesarean section was performed in four cases for obstetric reasons, and in seven cases it was planned by the urologist and gynecologist to avoid lead damage/displacement. Three pregnancies resulted in a vaginal delivery, and no association with term of delivery or duration of labor was observed. No congenital abnormalities related to SNM or lead displacement are reported, and only one patient required device removal because of significant loss of efficacy after childbirth. Conclusions The use of SNM during pregnancy appears to be safe, without morbidity for the fetus. Moreover, risks associated with switching the device off may be greater than benefits and justify maintaining the electrical stimulation throughout pregnancy. Keywords Delivery . Electrical stimulation . Peripheral nerve stimulation . Pregnancy . Sacral neuromodulation . Safety
Introduction Safety and effectiveness of sacral neuromodulation (SNM) during pregnancy and the impact of delivery on SMN function have not yet been fully established. Few animal models have been developed to study the effect of SMN on the endometrium [1], and most case reports and case series on humans agree
* Marco Agnello [email protected] 1
Università degli Studi di Torino-Scuola di Medicina-Dipartimento di Scienze Chirurgiche, Urologia U, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette (Corso Bramante 88), 10126 Torino, Italy
2
SC Neuro-Urologia, A.O.U. Città della Salute e della Scienza, Torino, Italy
with the parent company on turning the device off, because of its largely unknown effects on pregnancy and the fetus. On the other hand, keeping the device deactivated during pregnancy may increase the risk of urinary retention (UR) and urinary tract
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