New Percutaneous Technique of Sacral Nerve Stimulation Has High Initial Success Rate: Preliminary Results

Spinelli, M.; Giardiello, G.; Arduini, Andrea; Hombergh, Ubi van den

doi:10.1016/s0302-2838(02)00442-6

Cited by 149 publications

(80 citation statements)

References 24 publications

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“…Initially this was performed using an anchor system to the lumbodorsal fascia. 29,30 Subsequently, a lead with plastic tines was developed, which fixes the electrode in place without the need for additional anchoring 31 (FIG. 1 and FIG.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Mayer

Howard

2008

Neurotherapeutics

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Summary:Voiding dysfunction, which includes incontinence, retention, and chronic pelvic pain, is a relatively frequent problem that can be difficult to manage. Neuromodulation via stimulation of the sacral nerves has been shown to improve thesesymptoms, although the exact mechanisms remain elusive. Techniques for nerve stimulation may vary, depending on the disease, location of pain, and the patient's anatomy. In addition to placement of electrodes on the sacral nerve roots, modulation has also been reported by peripheral branches of the sacral nerves including the pudendal and posterior tibial nerves. Newer surgical techniques have significantly decreased the morbidity of the procedures and increased the probability of a successful outcome.

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Section: Surgical Techniquesmentioning

confidence: 99%

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Mayer

Howard

2008

Neurotherapeutics

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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%

“…At the beginning of the study, the conventional test electrode had to be removed and in the same place the permanent electrode (model 3080, Medtronic) was implanted in an open way and sutured to the fascia of the sacrum in 5 patients [10,11]. The internal stimulator IPG (InterStim model 3023, Medtronic) was placed in a subcutaneous pocket made on the opposite gluteal region of the implanted electrode and connected to the electrode.…”

Section: Surgical Techniquementioning

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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“…36 A less invasive technique in combination with a newly designed self-anchoring lead made it possible to test patients with this two-stage technique. 37,38 This 'tined lead' has four sets of self anchoring tines and made a minimally invasive percutaneous placement possible. The procedure can be performed under local anesthesia, requiring no additional incision and no additional anchoring.…”

Section: Technique Of Sacral Neuromodulationmentioning

confidence: 99%

“…The use of fluoroscopic localization of S3 allowed the introduction of a tined S3 lead and transformed the placement of a lead from an open procedure to a completely percutaneous one. 37,38 The widely adopted percutaneous use of a tined lead approach abandoned the need for fixation of the lead by methods such as bone anchors.…”

Section: Technique Of Sacral Neuromodulationmentioning

confidence: 99%

Sacral nerve stimulation for neuromodulation of the lower urinary tract

Oerlemans

Kerrebroeck

2007

Neurourology and Urodynamics

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Patients with symptoms of overactive bladder syndrome or non-obstructive urinary retention, refractory to conservative therapy, can nowadays be treated minimally invasively with sacral nerve stimulation (SNS). The use of electric currents to treat urological pathology has a long history but SNS therapy only received FDA approval in 1997. The mechanisms of action are still not known so there are different theories explaining the modulation effect. Recent studies have shown a central modulation effect. Predictive factors which can help to identify the perfect candidates are not known. Over the years the technique of SNS has become less invasive and because of two stage implantation test results have proven to be more reliable. The clinical results for this therapy have proven to be safe and effective and with the technical improvements over the years the re-operation and complication rates have decreased significantly. The clinical results have led to expanding indications because of positive effects in other symptoms. In the field of urology this has resulted in the use of SNS therapy for interstitial cystitis, neurogenic lower urinary dysfunction, and pediatric voiding dysfunction. In the field of gastro-intestinal pathology, SNS therapy is used to treat faecal incontinence and constipation.

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New Percutaneous Technique of Sacral Nerve Stimulation Has High Initial Success Rate: Preliminary Results

Cited by 149 publications

References 24 publications

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

New screening technique for sacral nerve stimulation under local anaesthesia

Sacral nerve stimulation for neuromodulation of the lower urinary tract

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