Improving neuromodulation technique for refractory voiding dysfunctions: Two-stage implant

Janknegt, R. A.; Weil, E.H.J.; Eerdmans, Pedro

doi:10.1016/s0090-4295(96)00506-7

Cited by 184 publications

(119 citation statements)

References 6 publications

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“…If subjects had 50% improvement in their urinary symptoms, they underwent second stage implantation of the IPG. Using this technique, Janknegt et al [1997] reported satisfactory results in 80% of women previously categorized as having failed PNE, thus qualifying them for IPG implantation. A similar high percentage of patients responding to the FSLP was also reported by Spinelli et al [2003] in a population of patients who had not previously undergone PNE.…”

Section: Introductionmentioning

confidence: 94%

“…This was thought to be due to migration of the electrode tip, resulting in a suboptimal test period [Janknegt et al, 1997;Carey et al, 2001]. To circumvent this problem, a two-stage approach for test stimulation was described in 1997.…”

Section: Introductionmentioning

confidence: 99%

“…Although these studies suggest that FSLP might be a better test stimulation technique than PNE, there have been no randomized studies comparing the two techniques. In addition, previous studies included a heterogenous population with either urinary urgency/frequency, retention, or urge incontinence [Janknegt et al, 1997;Scheepens et al, 2002;Spinelli et al, 2003].…”

Section: Introductionmentioning

confidence: 99%

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Predicting implantation with a neuromodulator using two different test stimulation techniques: A prospective randomized study in urge incontinent women

Borawski

Foster

Webster

et al. 2006

Neurourology and Urodynamics

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Aims: The purpose of this study was to determine whether a percutaneous needle electrode (PNE) technique or a surgical ¢rst stage lead placement (FSLP) better predicted whether a patient would progress to implantation of a pulse generator (IPG) in older urge incontinent women. Methods: Thirty subjects 55 years with refractory urge incontinence who had been selected to undergo a test stimulation procedure were randomized to either PNE or FSLP. Thirteen underwent PNE placement and seventeen underwent FSLP placement. If during the test stimulation period subjects had greater than 50% improvement in their incontinence parameters they quali¢ed for permanent lead and/or IPG implantation of the Interstim 1 device. Results: Twenty-one subjects (70%) responded to the test stimulation and underwent implantation, 15/17 (88%) in the FSLP group and 6/ 13 (46%) in the PNE group. Subjects who were randomized to the FSLP group were signi¢cantly more likely to proceed to implantation of the IPG (P ¼ 0.02) than those in the PNE group. There was no signi¢cant di¡erence in demographics, pre-test stimulation incontinence parameters or poststimulation visual analog pain scores between the randomized groups or between test stimulation responders and non-responders. When comparing FSLP and PNE responders, there was no signi¢-cant di¡erence in the percent improvement in 24-hr pad weight, daily pad usage, or daily incontinence. Conclusion: FSLP better predicted progression to implantation of the IPG than a test stimulation with a PNE in an older urge incontinent cohort. Neurourol. Urodynam. 26: 14^18, 2007. ß 2006

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predicting implantation with a neuromodulator using two different test stimulation techniques: A prospective randomized study in urge incontinent women

Borawski

Foster

Webster

et al. 2006

Neurourology and Urodynamics

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“…Patients with conventional test electrode had a median Wexner score of 13.5 (range, [8][9][10][11][12][13][14][15][16] and those with tined lead 15 (range, 6-20); p=0.553. All patients received single dose antibiotics preoperatively (1000 mg cefazolin and 500 mg metronidazole intravenously).…”

Section: Methodsmentioning

confidence: 99%

“…Due to a high migration rate of test electrodes and due to the invasiveness of open implantation of the permanent system [8], Spinelli et al [9], and the manufacture of the stimulator (Medtronic, Minneapolis, USA) recently developed a transcutaneous electrode (tined lead electrode) and a minimally invasive introducing kit. The new transcutaneous system is designed as a permanent electrode and can be used for both screening and permanent stimulation.…”

Section: Introductionmentioning

confidence: 99%

New screening technique for sacral nerve stimulation under local anaesthesia

et al. 2005

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performed at the same time under local anaesthesia. The use of the new tined lead electrode significantly increased the success rate for the screening phase. Key words Faecal incontinence• Sacral nerve stimulation • Minimally invasive sacral neuromodulation • Tined lead electrode IntroductionSacral nerve stimulation (SNS) is an amazing therapy option for patients with urinary and bowel dysfunction [1][2][3][4][5][6]. The procedure involves three stages. The first step is a percutaneous nerve evaluation with a foramen needle. If a contraction of the pelvic floor can be observed, the second step consists of introducing a test electrode and an external pulse generator for a screening phase of 10-14 days. In patients with a positive response (symptoms decrease of more than 50% measured by a continence diary), the third step replaces the test electrode with a permanent electrode, and a definitive implantation of the "internal pulse generator" (IPG) can be performed [1,7].However, the technique of SNS for the treatment of faecal incontinence is not standardised yet. Due to a high migration rate of test electrodes and due to the invasiveness of open implantation of the permanent system [8], Spinelli et al. [9], and the manufacture of the stimulator (Medtronic, Minneapolis, USA) recently developed a transcutaneous electrode (tined lead electrode) and a minimally invasive introducing kit. The new transcutaneous system is designed as a permanent electrode and can be used for both screening and permanent stimulation. It is supposed to improve the success rate of screening by decreasing the risk of electrode migration. In addition, implantation of the new tined lead electrode can be performed under local anaesthesia. Thereafter, the patient can feel and localise the stimulation Abstract BackgroundThe purpose of this study was to assess the influence of the type of anaesthesia (local vs. general) and of the electrode used (test electrode vs. tined lead) on a successful screening period. Methods Between May 2001 and January 2004, we performed 25 percutaneous nerve evaluation (PNE) tests in 20 patients (11 women). The first 15 PNE tests were followed by introducing a conventional electrode, and since 2003 by a tined lead electrode. Success was defined as reduction of symptoms by more than 50%. Results A stimulator was implanted in 13 (68%) patients, including 4 of 14 screened with the conventional electrode and 9 of 10 screened with tined lead electrode (p=0.005). Eleven (44%) of the PNE tests were done under local anaesthesia, but the success rate was not influenced by the type of anaesthesia (local 46% vs. general 61%, p=0.682). Conclusions PNE testing and implantation of the tined lead electrode can be easily Tech Coloproctol (2005) 9:25-28

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Electrical stimulation with non-implanted electrodes for urinary incontinence in adults

Berghmans¹,

Bø²,

Hendriks³

et al. 2004

Cochrane Database of Systematic Reviews

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Improving neuromodulation technique for refractory voiding dysfunctions: Two-stage implant

Cited by 184 publications

References 6 publications

Predicting implantation with a neuromodulator using two different test stimulation techniques: A prospective randomized study in urge incontinent women

Predicting implantation with a neuromodulator using two different test stimulation techniques: A prospective randomized study in urge incontinent women

New screening technique for sacral nerve stimulation under local anaesthesia

Electrical stimulation with non-implanted electrodes for urinary incontinence in adults

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