Removal of sacral neuromodulation quadripolar tined-lead using a straight stylet: description of a surgical technique

Abstract

Background Up to 7.5% of tined-lead removals in patients having sacral neuromodulation (SNM) therapy are associated with a lead breakage. It is still unclear what adverse effects can be caused by unretrieved fragments. The aim of our study was to describe the lead removal technique we have been using for the last 2 years in our centre. Methods We retrospectively enrolled patients who had lead removal between January 2018 and January 2020 using our standardized technique. The novelty of the technique is in the use of the straight stylet, which is available in the quadripolar tined-lead kit. The stylet gives the electrode greater stiffness, reducing interactions with surrounding tissues and probability of damage or breakage during removal. Results In 59 patients (42 women, mean age 57.2 years [range 40–79 years]) the lead was removed using our standardized technique. In 44 of 59 patients, the tined-lead was removed within 2 months from the SNM-test, due to lack of beneficial effects. In 15 patients the electrode was removed because of failure of definitive implantation. Meantime from definitive implantable pulse generator (IPG) implantation to lead removal was 67.9 months. We recorded only 1 case of lead-breakage during removal: a female patient with a non-tined lead fixed on sacral bone, placed 18 years previously using an open technique. Conclusions Lead breakage during removal is not uncommon and adverse effects of retained fragments may occur. Our technique has been safely used for the last 2 years in our centre, with no episodes of lead breakage or retained fragments, except for one non-tined electrode.

Temporary Gasserian ganglion stimulation utilizing SNM electrode in subacute herpetic trigeminal neuralgia

“…However, our previous cohort study on sacral nerve stimulation using SNM lead in patients with pudendal neuralgia did not find any complications related to lead breakage during removal ( 37 ). In addition, it is possible to avoid electrode breakage by employing appropriate surgical techniques ( 38 ). Therefore, the quadripolar tined lead designed for SNM might be a safe and suitable choice for herpetic neuralgia.…”

Outcomes and efficacy of magnetic resonance imaging-compatible sacral nerve stimulator for management of fecal incontinence: A multi-institutional study

“…In those patient groups, either the sacral neuromodulation (SNM) treatment was not offered or lead removal was done in case MRI was needed. Approximately 15%-18% of SNM-implanted patients have required an explantation of the device for a variety of reasons, one being patients requiring MRI[ 14 - 17 ]. One study showed that almost 23% of total removals were attributed to patients requiring MRI[ 18 ].…”