How do you proceed if you cannot get a bellows reflex during stage 1 sacral neuromodulation procedure?

It depends on whether you can get great toe plantar flexion, or if the patient is awake, and if you get good sensation. If there is good "toe" and/or sensation, then it's reasonable to test that side; however, if you don't get either and based on fluoroscopy you are sure you are in S3 and depth good...