Sacral Neuromodulation (SNM): Can Percutaneous Nerve Evaluation (PNE) Really Compete with Stage 1 to Predict Outcomes?

To summarize up to date literature comparing percutaneous nerve evaluation (PNE) to the Staged lead approach in identifying optimal candidates for sacral neuromodulation (SNM) in the management of overactive bladder (OAB) or neurogenic bladder (NGB). Additionally, to understand pros and cons of each procedure including patient specific factors, patient experience, and cost to the healthcare system. In general, a staged approach has better predictability for those who may benefit from SNM for urinary symptoms. However, the reliability of PNE has increased with advancements to the monopolar lead. Stage 1 tined lead test is superior at predicting patients who may benefit from SNM, but PNE has undergone recent advancements improving its efficacy and should be considered a viable option for testing in select patients. Head to head studies are necessary to compare symptom outcomes, patient experience and cost effectiveness of each approach.