Safety of prolonged sacral neuromodulation tined lead testing

Kessler, Thomas M.; Burkhard, Fiona C.; Madersbacher, H.; Kofler, Alexandra; Poewe, Werner; Kiss, Gustav

doi:10.1185/030079908x253555

Cited by 39 publications

(20 citation statements)

References 14 publications

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“…Advances in technical issues have facilitated the use of the same electrode during the test phase and implantation of the generator (staged implant procedure) [4,5], and may improve the results [6,7]. With tined lead electrodes, an extended trial period, even lasting for 2 weeks, is possible, and is a safe alternative before implantation of the neuromodulator [8]. However, at least in painful bladder syndrome, there is no difference in the longterm outcome in terms of the trial test stimulation method used (conventional percutaneous testing vs tined lead device) [9].…”

Section: Introductionmentioning

confidence: 98%

Sacral neuromodulation in urological indications: The Finnish experience

Vaarala

Tammela

Perttilä³

et al. 2010

Scandinavian Journal of Urology and Nephrology

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The difference in gender distribution compared with earlier published series may be explained by a selection bias due to the limited referrals of female patients from gynaecologists. The results favour the use of a tined lead device because of the shorter operating room time. Furthermore, the outcome seems to be more favourable among patients with a staged implant procedure compared with a one-stage operation with a tined lead device.

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Section: Introductionmentioning

confidence: 98%

Sacral neuromodulation in urological indications: The Finnish experience

Vaarala

Tammela

Perttilä³

et al. 2010

Scandinavian Journal of Urology and Nephrology

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“…This is because of the fact that, in the first stage, only the permanent electrode is implanted in the sacral S3 root and connected to a temporary external stimulator, allowing patients to be assessed for a longer period (minimum 1 month) and with a more accurate evaluation of possible clinical enhancement as the risk of lead migration with the peripheral nerve evaluation (PNE) test is eliminated. 3 If the main symptoms improve by more than half during the first stage, compared with baseline, the patient proceeds to the second stage, the insertion of the implantable pulse generator (IPG). The range of SNM indications has been extended continuously beyond voiding disorders.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome of sacral neuromodulation in incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms

Lombardi

Popolo

2009

Spinal Cord

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Objective: To determine the efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord injured (SCI) subjects affected by neurogenic lower urinary tract symptoms (NLUTS). Methods: Twenty-four SCI patients were enrolled. The individuals were divided into two groups: 13 individuals in the urinary retention category and 11 suffering from overactive bladder syndrome. All subjects underwent definitive SNM implantation (Medtronic, Inc.). Voiding symptoms were assessed using patient bladder diaries, which recorded both pre-SNM and before each follow-up (1, 3 and 6 months, and then every 6 months). Outcome measures were per 24 h: number of voids and voided volume per void for both groups; number of urinary leakages, pad use and nocturia for patients with overactive bladder syndrome; and volume per catheterization and number of catheterizations for urinary retention subjects only. Final checkups were completed by June 2008. Results: Median follow-up was 61 months. Up to the final visit, all subjects maintained a clinical improvement of more than 50% compared with baseline. Twenty-two side effects were recorded. Four subjects with urinary retention needed a new implant in the controlateral S3 sacral root because of loss of efficacy. One patient with urinary retention developed a wound infection at the implanted pulse generator site. Conclusions: Our study contains the largest series of implanted SCI patients ever published. SNM is a therapy to consider in the treatment of NLUTS for partial SCI patients, even if the loss of clinical benefits for patients with retentive NLUTS must be taken into account. All adverse events were treated effectively.

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“…Durch Verbesserung der Implantationstechnik und der einzelnen Implantatkomponenten wurde in den letzten Jahren nicht nur die Invasivität verringert, sondern auch die Aussagekraft der Testphase durch Verlänge-rung der Testzeit mit definitiven Elektroden verbessert [10], ohne damit die Komplikationsrate zu erhöhen [11,12]. Die SNM ist in ein "Mehr-Schritt-Verfahren": In einem ersten Schritt werden die Sakralforamina S3 und/oder S4 mit einer Foramennadel punktiert.…”

Section: Technik Der Snmunclassified

Sakrale Neuromodulation bei neurogenen Blasenfunktionsstörungen

Kessler

Wöllner

Kozomara

et al. 2012

Urologe

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Sacral neuromodulation (SNM) represents a promising option for managing treatment-refractory neurogenic bladder dysfunction. It remains to be seen, however, which types of neurogenic bladder dysfunction and which underlying neurological disorders best respond to SNM. Constant improvements in SNM have been achieved and it is now a minimally invasive approach performed under local anesthesia which should be considered before undertaking larger reconstructive procedures. An electrode is implanted in the S3 or S4 sacral foramen and during a test phase lasting for days to weeks the patient keeps a bladder diary to determine whether SNM has provided a relevant benefit. If the results of the test phase are positive, a neuromodulator is implanted in the gluteal area (or more rarely in the abdominal wall).The mechanism of action of SNM has not been completely clarified, but the afferent nerves most likely play a key role. It appears that SNM produces a modulation of medullary reflexes and brain centers by peripheral afferents. The implanted neuromodulation system does not lead to limitation of the patient's activities. However, it should be noted that high-frequency diathermy and unipolar electrocauterization are contraindicated in patients with neuromodulators, that during extracorporeal shock wave lithotripsy the focal point should not be in the direct vicinity of the neuromodulator or the electrode, that ultrasound and radiotherapy in the region of the implanted components should be avoided, that the neuromodulation should be discontinued in pregnancy, and that MRI examinations should only be conducted when urgently indicated and the neuromodulator is turned off.

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Safety of prolonged sacral neuromodulation tined lead testing

Cited by 39 publications

References 14 publications

Sacral neuromodulation in urological indications: The Finnish experience

Sacral neuromodulation in urological indications: The Finnish experience

Clinical outcome of sacral neuromodulation in incomplete spinal cord injured patients suffering from neurogenic lower urinary tract symptoms

Sakrale Neuromodulation bei neurogenen Blasenfunktionsstörungen

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