New screening technique for sacral nerve stimulation under local anaesthesia

Abstract

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

How Does Sacral Modulation Work Best? Placement and Programming Techniques to Maximize Efficacy

“…Evaluation by PNE accomplished under local anesthesia facilitates the opportunity to use the patient's sensation feedback of the acute SNM so that the identification of the optimal temporary electrode position can be planned (with regard to the anticipated implant of the permanent electrode) [16]. In contrast to electrode introduction under general anesthesia, with the contraction of the external anal sphincter and the pelvic floor as the sign of optimal positioning (motoric response), the patient's sensation under local anesthesia allows targeted positioning with regard to anterior, posterior, or even intrapelvic feeling.…”

Incontinence fécale et stimulation des racines sacrées

“…Le repérage de la meilleure réponse motrice est le plus souvent visuel, mais il est possible d'utiliser la manométrie anorectale et/ou l'électromyogramme pour quantifier la réponse motrice anale [6]. Certaines équipes testent systématiquement toutes les positions et choisissent la meilleure à la fin du test [5,7,8]. Parfois, deux électrodes sont laissées en place de façon à tester alternativement, pendant plusieurs jours, lors du test chronique, les deux positions [9].…”

“…La seconde est l'électrode définitive, à ailettes, également tunellisée, utilisée au cours de l'implantation définitive du système (Electrode définitive 3097, Interstim) [11]. Il semblerait que l'électrode permanente permette une meilleure sélec-tion des patients candidats à l'implantation [8,12]. Une des raisons principales pour cela est que cette électrode ne migre pas et permet donc d'effectuer une période test plus longue et plus représentative de l'état clinique du patient après implantation.…”

Stimulation des racines sacrées et incontinence fécale : résultats d’une expérience collective

“…Le type d'anesthésie utilisée (i.e. : locale ou générale) ne semble pas influencer le succès du test temporaire de stimulation [35]. Le type d'anesthésie utilisée est laissé au choix des opérateurs par les participants à la réunion.…”

“…3), également tunnellisée, utilisée au cours de l'implantation définitive du système (électrode définitive 3097, Interstim) [36]. Il semblerait que l'électrode permanente permette une meilleure sélection des patients candidats à l'implantation [35,37]. Une des raisons principales pour cela est que cette électrode ne migre pas et permet donc d'effectuer une période test plus longue et plus représentative de l'état clinique du patient après implantation.…”