Optimizing Lead Placement in Sacral Neuromodulation

Couvaras, Anastasia; Goudelocke, Colin

doi:10.1007/s11884-021-00634-3

Cited by 3 publications

(3 citation statements)

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“…The quality of lead placement during SNM-I is critical for success of staged trial testing. 3 As such, a number of studies focused on identifying and optimizing factors which may influence successful lead placement. We believe our study is the first to evaluate outcomes based on use of MAC or GA during SNM-I.…”

Section: Discussionmentioning

confidence: 99%

“…Advantages of MAC include patient reported sensory responses to sacral stimulation in addition to observation of patient motor reflexes by the surgeon during the procedure. The combination of responses is considered ideal for assessing adequacy of lead placement 3 . With GA, only motor reflexes are assessable.…”

Section: Introductionmentioning

confidence: 99%

“…The combination of responses is considered ideal for assessing adequacy of lead placement. 3 With GA, only motor reflexes are assessable. However, several studies have suggested evaluation of motor reflexes without sensory responses is adequate for successful lead placement.…”

mentioning

confidence: 99%

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Does choice of anesthesia during stage 1 sacral neuromodulation testing influence outcomes?

Waldoch,

Anderson,

Narveson

et al. 2024

Neurourology and Urodynamics

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IntroductionStaged sacral neuromodulation (SNM) testing has been shown to have a high rate of progression to permanent implantation for the management of voiding dysfunction. Stage 1 lead placement (SNM‐I) can be performed under monitored anesthesia care (MAC) or general anesthesia (GA). MAC allows for interpretation of sensory and motor responses to optimize lead placement while GA only permits for motor assessment. However, patient discomfort and movement can make lead placement challenging during MAC. Herein we evaluate whether the anesthesia type impacts the progression rate to permanent implantation (SNM‐II).Materials and MethodsA retrospective chart review was performed for patients who underwent SNM‐I in the operating room for wet overactive bladder between 2005 and 2023. Patients were divided into two groups based on the type of anesthesia used, MAC or GA. Clinical variables and progression to SNM‐II were compared between cohorts. Progression to SNM‐II was based on ≥50% symptomatic improvement during a 1−2 week trial period following SNM‐I.ResultsOf 121 patients included in the study, 95 (79%) underwent MAC and 26 (21%) GA for SNM‐I. No difference in the progression rate to SNM‐II was noted between groups (MAC, 68/95 patients, 72%; GA, 19/26, 73%; p = 0.39). We also found no difference when comparing the GA group to the 26 most recent MAC patients (MAC, 20/26 patients, 77%; GA, 19/26, 73%; p = 0.48).ConclusionTypes of anesthesia for SNM‐I did not affect rate of progression to SNM‐II. The result lends support to the reliance on motor responses alone for lead placement during SNM‐I.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%