New Tined Lead Electrode in Sacral Neuromodulation: Experience from a Multicentre European Study

Spinelli, M.; Weil, E.H.J.; Ostardo, Edoardo; Popole, G. Del; Ruiz-Cerdá, J.L.; Kiss, Gustav; Heesakkers, John

doi:10.1016/s0022-5347(05)00635-x

Cited by 27 publications

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“…This minimally invasive permanent tined lead o¡ers many advantages over the traditional PNE followed by non-tined lead placement [Spinelli et al, 2003[Spinelli et al, , 2005. Not only does the percutaneous trans-foraminal approach eliminate the need for a large, deep incision for non-tined anchoring of the lead, it also allows for the use of local anesthesia, which enables the incorporation of sensory responses during intra-operative test stimulation for optimal localization of the permanent lead.…”

Section: Discussionmentioning

confidence: 99%

Sacral nerve stimulation for voiding dysfunction: One institution's 11‐year experience

Sutherland

Lavers

Carlson³

et al. 2006

Neurourology and Urodynamics

125

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Aim: The purpose of this study was to review our institution's 11-year experience with SNS for the treatment of refractory voiding dysfunction. Dating back to 1993, it covers a span of time which describes the evolution of SNS as it includes PNE trials, non-tined (bone-anchored or fascial-anchored) leads, percutaneous tined leads with two-staged procedures, and even percutaneous pudendal trials. Methods: A retrospective review was performed on SNS patients who received an implantable pulse generator (IPG) in our practice from 12/1993 to 12/2004. After Institutional Review Board approval, consents for chart review were obtained from 104 patients, representing 44% of this neuromodulatory patient population. Results: Of our population, 87% were female and 13% were male. Average age at implant was 50 years AE 13.4 years. Duration of symptoms before implantation was 116 months (range 9^600 months). Eighty percent were implanted for a predominant complaint of urinary urgency and frequency (U/F). Overall, 22% had U/F only, 38% had concomitant urge incontinence (UI), and 20% had concomitant mixed incontinence (MI). Twenty percent were treated for non-obstructive urinary retention (UR), with half of these associated with a neurogenic etiology. Additionally, 46.2% had pelvic pain, 58.6% had bowel complaints, and 51% reported sexual dysfunction. In patients with U/F, mean voiding parameters as described by pre-implant voiding diaries revealed the following: 12.4 (AE5.1) voids per 24 hr; 2.3 (AE1.8) voids per night; 5.0 (AE4.7) leaks per 24 hr; and 2.3 (AE2.6) pads per 24 hr. Statistically signi¢cant improvements post-implantation were noted with mean decreases in the following: 4.3 voids per 24 hr; 1.0 void per night; 4.4 leaks per 24 hr; and 2.3 pads per 24 hr (all P < 0.05). In the UR group a statistically signi¢cant improvement post-implantation was noted only in voids per night, with a mean decrease of 0.8 (P < 0.05). With a mean follow up of 22 months (range 3^162 months), sustained subjective improvement was >50%, >80%, and >90% in 69%, 50%, and 35% of patients, respectively. By quality of life survey, 60.5% of patients were satis¢ed and 16.1% were dissatis¢ed with current urinary symptoms. Only 13% (14 patients) abandoned therapy, making up a signi¢cant portion of those dissatis¢ed with current urinary symptoms. Good overall lead durability was seen (mean 22 months, range 1^121 months), with the ¢rst successful lead proving to be the most durable (mean 28 months, range 1.41 20 months). Lead durability decreased progressively with subsequent trials. Overall, 53% of patients experienced at least one reportable event (RE) attributable to either lead or IPG. A total of 126 REs were noted, with 97% mild-to-moderate in severity. REs included lack of e⁄cacy, loss of e⁄cacy, infection, hematoma/seroma, migration, pain, undesirable change in sensation, and device malfunction. In this population, 47.1% of leads were tined while 52.9% were non-tined. Tined leads had an overall lower RE rate as compared to non-tined leads: 28% ...

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Section: Discussionmentioning

confidence: 99%

Sacral nerve stimulation for voiding dysfunction: One institution's 11‐year experience

Sutherland

Lavers

Carlson³

et al. 2006

Neurourology and Urodynamics

125

View full text Add to dashboard Cite

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“…Sacral neuromodulation was performed with the Interstim Continence Control System 1 utilizing a 2 stage implantation technique that has been previously described [Spinelli et al, 2005]. All patients received broad-spectrum preoperative intravenous antibiotics consisting of vancomycin and gentamicin prior to implantation.…”

Section: Methodsmentioning

confidence: 99%

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Starkman

Wolter

Scarpero

et al. 2006

Neurourology and Urodynamics

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Aims: We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. Methods: A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: signi¢cant response (80% improvement), moderate response (50% and <80% improvement), and poor response (<50% response). Results: Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal ¢stula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no signi¢cant di¡erences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. Conclusion: Sacral neuromodulation appears to be an e¡ec-tive therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality. Neurourol. Urodynam. 26: 29^35, 2007. ß 2006

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“…Another report, also from Europe, also indicated that ϳ75% of patients undergoing a staged procedure did have a positive test, allowing implantation of a pulse generator, when the screening was performed for an average of 30 days. 34 A number of reports have also been published regarding possible factors that could have predictive value. During implantation of the percutaneous electrode, both motor response and sensory response are obtained to determine S3 nerve root stimulation (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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New Tined Lead Electrode in Sacral Neuromodulation: Experience from a Multicentre European Study

Cited by 27 publications

References 0 publications

Sacral nerve stimulation for voiding dysfunction: One institution's 11‐year experience

Sacral nerve stimulation for voiding dysfunction: One institution's 11‐year experience

Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation

Sacral Nerve Stimulation: Neuromodulation for Voiding Dysfunction and Pain

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