Skip to main content
Top
Published in: Current Urology Reports 5/2011

01-10-2011

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

Authors: Bastian Amend, Mahmoud Khalil, Thomas M. Kessler, Karl-Dietrich Sievert

Published in: Current Urology Reports | Issue 5/2011

Login to get access

Abstract

Since receiving approval from the US Food and Drug Administration in 1997, sacral neuromodulation (SNM) has become the recommended treatment of urinary urge incontinence, urgency–frequency, nonobstructive urinary retention, and fecal incontinence. The manufacturer has introduced different technical modifications while surgeons and researchers have adapted and published various innovations and alterations of the technique. This review summarizes the current knowledge and recommendations of SNM preoperative decision making, the implantation technique, and available programming parameters and algorithms based on MEDLINE research, manufacturer instructions, and the approach of an experienced neurourological team. The primary steps and technical aspects to optimize SNM efficacy were the introduction of the tined-lead electrode and the development of the InterStim II impulse generator (both developed by Medtronic, Inc., Minneapolis, MN). The initiation of the staged implantation technique for sequential evaluation and implantation with the definitive quadripolar electrode completes the treatment algorithm so that an increased responder rate of SNM for all indications can be achieved.
Literature
1.
go back to reference Schmidt RA, Jonas U, Oleson KA, et al. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group. J Urol. 1999;162:352–7.PubMedCrossRef Schmidt RA, Jonas U, Oleson KA, et al. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group. J Urol. 1999;162:352–7.PubMedCrossRef
2.
go back to reference • Matzel KE, Lux P, Heuer S et al. Sacral nerve stimulation for faecal incontinence: long-term outcome. Colorectal Dis. 2009;11:636–41. Although the authors reported a small group of patients, an outstanding long follow-up of nearly 10 years has been described for the efficacy of SNM for fecal incontinence. PubMedCrossRef • Matzel KE, Lux P, Heuer S et al. Sacral nerve stimulation for faecal incontinence: long-term outcome. Colorectal Dis. 2009;11:636–41. Although the authors reported a small group of patients, an outstanding long follow-up of nearly 10 years has been described for the efficacy of SNM for fecal incontinence. PubMedCrossRef
3.
go back to reference Oerlemans DJ, Van Kerrebroeck PE. Sacral nerve stimulation for neuromodulation of the lower urinary tract. Neurourol Urodyn. 2008;27:28–33.PubMedCrossRef Oerlemans DJ, Van Kerrebroeck PE. Sacral nerve stimulation for neuromodulation of the lower urinary tract. Neurourol Urodyn. 2008;27:28–33.PubMedCrossRef
4.
go back to reference •• Abrams P, Andersson KE, Birder L et al.: 4th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. 4th edition. 2009. The recommendadtions of the fourth ICI summarize the current state of the art of urinary and fecal incontinence management. The information guides for an successful treatment. •• Abrams P, Andersson KE, Birder L et al.: 4th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. 4th edition. 2009. The recommendadtions of the fourth ICI summarize the current state of the art of urinary and fecal incontinence management. The information guides for an successful treatment.
5.
go back to reference Van Kerrebroeck PE, Van Voskuilen AC, Heesakkers JP, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178:2029–34.PubMedCrossRef Van Kerrebroeck PE, Van Voskuilen AC, Heesakkers JP, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178:2029–34.PubMedCrossRef
6.
go back to reference • Wexner SD, Coller JA, Devroede G et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. (2010), 251:441–449. The authors report on SNM for fecal incontinence with follow-up of 28 months. Safety and efficacy of SNM for fecal incontinence was concluded. PubMedCrossRef • Wexner SD, Coller JA, Devroede G et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. (2010), 251:441–449. The authors report on SNM for fecal incontinence with follow-up of 28 months. Safety and efficacy of SNM for fecal incontinence was concluded. PubMedCrossRef
7.
go back to reference Uludag O, Melenhorst J, Koch SM et al. Sacral neuromodulation: long term outcome and quality of life in patients with faecal incontinence. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland (2010). Uludag O, Melenhorst J, Koch SM et al. Sacral neuromodulation: long term outcome and quality of life in patients with faecal incontinence. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland (2010).
8.
go back to reference • Haddad M, Besson R, Aubert D et al. Sacral neuromodulation in children with urinary and fecal incontinence: a multicenter, open label, randomized, crossover study. J Urol. 2010;184:696–701. The authors conducted one of the first randomized trials for SNM in a pediatric population. Superiority of SNM over conservative treatment for urinary and fecal incontinence was reported. The authors recommend consideration of SNM before irreversible surgery for children. PubMedCrossRef • Haddad M, Besson R, Aubert D et al. Sacral neuromodulation in children with urinary and fecal incontinence: a multicenter, open label, randomized, crossover study. J Urol. 2010;184:696–701. The authors conducted one of the first randomized trials for SNM in a pediatric population. Superiority of SNM over conservative treatment for urinary and fecal incontinence was reported. The authors recommend consideration of SNM before irreversible surgery for children. PubMedCrossRef
9.
go back to reference Alloussi S, Loew F, Mast GJ. Wolf D [Selective sacral nerve blockade in the treatment of detrusor hyperreflexia of the bladder]. Urologe A. 1984;23:39–45.PubMed Alloussi S, Loew F, Mast GJ. Wolf D [Selective sacral nerve blockade in the treatment of detrusor hyperreflexia of the bladder]. Urologe A. 1984;23:39–45.PubMed
10.
go back to reference Amundsen CL, Romero AA, Jamison MG. Webster GD Sacral neuromodulation for intractable urge incontinence: are there factors associated with cure? Urology. 2005;66:746–50.PubMedCrossRef Amundsen CL, Romero AA, Jamison MG. Webster GD Sacral neuromodulation for intractable urge incontinence: are there factors associated with cure? Urology. 2005;66:746–50.PubMedCrossRef
11.
go back to reference Kessler TM, La Framboise D, Trelle S, et al. Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and meta-analysis. Eur Urol. 2010;58:865–74.PubMedCrossRef Kessler TM, La Framboise D, Trelle S, et al. Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and meta-analysis. Eur Urol. 2010;58:865–74.PubMedCrossRef
12.
go back to reference Amend B, Castro-Diaz D, Chartier-Kastler E, et al. Second-line therapy of idiopathic detrusor overactivity. Sacral neuromodulation and botulinum toxin A. Urologe A. 2010;49:245–52.PubMedCrossRef Amend B, Castro-Diaz D, Chartier-Kastler E, et al. Second-line therapy of idiopathic detrusor overactivity. Sacral neuromodulation and botulinum toxin A. Urologe A. 2010;49:245–52.PubMedCrossRef
13.
go back to reference •• Thuroff JW, Abrams P, Andersson KE et al. EAU Guidelines on Urinary Incontinence. Eur Urol. 2011;59:387–400. The European Association of Urology offers well-structured and clinically oriented guidelines for the treatment of urinary incontinence. These guidelines should be introduced into daily patient care PubMedCrossRef •• Thuroff JW, Abrams P, Andersson KE et al. EAU Guidelines on Urinary Incontinence. Eur Urol. 2011;59:387–400. The European Association of Urology offers well-structured and clinically oriented guidelines for the treatment of urinary incontinence. These guidelines should be introduced into daily patient care PubMedCrossRef
14.
go back to reference Maeda Y, Laurberg S. Sacral nerve stimulation: time for critical appraisal. Ann Surg (2011). Maeda Y, Laurberg S. Sacral nerve stimulation: time for critical appraisal. Ann Surg (2011).
15.
go back to reference • Spinelli M, Sievert KD. Latest technologic and surgical developments in using InterStim Therapy for sacral neuromodulation: impact on treatment success and safety. Eur Urol. 2008;54:1287–96. This article accompanies a "surgery in motion" video that demonstrates the basics of SNM with stepwise surgical instruction. Additionally, recent changes and further development of the PNE and the tined-lead procedures are summarized. PubMedCrossRef • Spinelli M, Sievert KD. Latest technologic and surgical developments in using InterStim Therapy for sacral neuromodulation: impact on treatment success and safety. Eur Urol. 2008;54:1287–96. This article accompanies a "surgery in motion" video that demonstrates the basics of SNM with stepwise surgical instruction. Additionally, recent changes and further development of the PNE and the tined-lead procedures are summarized. PubMedCrossRef
16.
go back to reference Hetzer FH, Hahnloser D, Knoblauch Y, et al. New screening technique for sacral nerve stimulation under local anaesthesia. Tech Coloproctol. 2005;9:25–8.PubMedCrossRef Hetzer FH, Hahnloser D, Knoblauch Y, et al. New screening technique for sacral nerve stimulation under local anaesthesia. Tech Coloproctol. 2005;9:25–8.PubMedCrossRef
17.
go back to reference Cohen BL, Tunuguntla HS, Gousse A. Predictors of success for first stage neuromodulation: motor versus sensory response. J Urol. 2006;175:2178–80. discussion 2180–1.PubMedCrossRef Cohen BL, Tunuguntla HS, Gousse A. Predictors of success for first stage neuromodulation: motor versus sensory response. J Urol. 2006;175:2178–80. discussion 2180–1.PubMedCrossRef
18.
go back to reference • Govaert B, Melenhorst J, Van Gemert WG, Baeten CG. Can sensory and/or motor reactions during percutaneous nerve evaluation predict outcome of sacral nerve modulation? Dis Colon Rectum. 2009;52:1423–6. The authors investigated motor or sensory responses to SNM with equal responses to SNM. They concluded that patients with only sensory response naturally benefit from a procedure performed under local anesthesia. PubMedCrossRef • Govaert B, Melenhorst J, Van Gemert WG, Baeten CG. Can sensory and/or motor reactions during percutaneous nerve evaluation predict outcome of sacral nerve modulation? Dis Colon Rectum. 2009;52:1423–6. The authors investigated motor or sensory responses to SNM with equal responses to SNM. They concluded that patients with only sensory response naturally benefit from a procedure performed under local anesthesia. PubMedCrossRef
19.
go back to reference Janknegt RA, Weil EH, Eerdmans PH. Improving neuromodulation technique for refractory voiding dysfunctions: two-stage implant. Urology. 1997;49:358–62.PubMedCrossRef Janknegt RA, Weil EH, Eerdmans PH. Improving neuromodulation technique for refractory voiding dysfunctions: two-stage implant. Urology. 1997;49:358–62.PubMedCrossRef
20.
go back to reference Spinelli M, Malaguti S, Giardiello G, et al. A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: description of the method and preliminary data. Neurourol Urodyn. 2005;24:305–9.PubMedCrossRef Spinelli M, Malaguti S, Giardiello G, et al. A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: description of the method and preliminary data. Neurourol Urodyn. 2005;24:305–9.PubMedCrossRef
21.
go back to reference Everaert K, Kerckhaert W, Caluwaerts H, et al. A prospective randomized trial comparing the 1-stage with the 2-stage implantation of a pulse generator in patients with pelvic floor dysfunction selected for sacral nerve stimulation. Eur Urol. 2004;45:649–54.PubMedCrossRef Everaert K, Kerckhaert W, Caluwaerts H, et al. A prospective randomized trial comparing the 1-stage with the 2-stage implantation of a pulse generator in patients with pelvic floor dysfunction selected for sacral nerve stimulation. Eur Urol. 2004;45:649–54.PubMedCrossRef
22.
go back to reference Peters KM, Carey JM, Konstandt DB. Sacral neuromodulation for the treatment of refractory interstitial cystitis: outcomes based on technique. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:223–8. discussion 228.PubMedCrossRef Peters KM, Carey JM, Konstandt DB. Sacral neuromodulation for the treatment of refractory interstitial cystitis: outcomes based on technique. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:223–8. discussion 228.PubMedCrossRef
23.
go back to reference Scheepens WA, Van Koeveringe GA, De Bie RA, et al. Long-term efficacy and safety results of the two-stage implantation technique in sacral neuromodulation. BJU Int. 2002;90:840–5.PubMedCrossRef Scheepens WA, Van Koeveringe GA, De Bie RA, et al. Long-term efficacy and safety results of the two-stage implantation technique in sacral neuromodulation. BJU Int. 2002;90:840–5.PubMedCrossRef
24.
go back to reference • Marcelissen T, Leong R, Serroyen J et al. Is the screening method of sacral neuromodulation a prognostic factor for long-term success? J Urol. 2011;185:583–7. The authors investigated the different screening methods of SNM in regard to the responder rate and efficacy. They reported the staged procedure to be more sensitive than PNE, but long-term success seems to be equal if patients without a positive PNE test were offered evaluation with the tined-lead electrode. PubMedCrossRef • Marcelissen T, Leong R, Serroyen J et al. Is the screening method of sacral neuromodulation a prognostic factor for long-term success? J Urol. 2011;185:583–7. The authors investigated the different screening methods of SNM in regard to the responder rate and efficacy. They reported the staged procedure to be more sensitive than PNE, but long-term success seems to be equal if patients without a positive PNE test were offered evaluation with the tined-lead electrode. PubMedCrossRef
25.
go back to reference Hauck EF, Schwefer M, Wittkowski W, Bothe HW. Measurements and mapping of 282,420 nerve fibers in the S1-5 nerve roots. J Neurosurg Spine. 2009;11:255–63.PubMedCrossRef Hauck EF, Schwefer M, Wittkowski W, Bothe HW. Measurements and mapping of 282,420 nerve fibers in the S1-5 nerve roots. J Neurosurg Spine. 2009;11:255–63.PubMedCrossRef
26.
go back to reference Leong RK, De Wachter SG, Nieman FH et al. PNE versus 1st stage tined lead procedure: A direct comparison to select the most sensitive test method to identify patients suitable for sacral neuromodulation therapy. Neurourology and urodynamics 2011. Leong RK, De Wachter SG, Nieman FH et al. PNE versus 1st stage tined lead procedure: A direct comparison to select the most sensitive test method to identify patients suitable for sacral neuromodulation therapy. Neurourology and urodynamics 2011.
27.
go back to reference Benninghoff D. Anatomy. München: Urban & Fischer Verlag; 2003. Benninghoff D. Anatomy. München: Urban & Fischer Verlag; 2003.
28.
go back to reference Amend B, Matzel KE, Abrams P et al. How does neuromodulation work: ICI-RS 2010? Neurourology and urodynamics 2011. Amend B, Matzel KE, Abrams P et al. How does neuromodulation work: ICI-RS 2010? Neurourology and urodynamics 2011.
29.
go back to reference Swinn MJ, Schott GD, Oliver SE, et al. Leg pain after sacral neuromodulation: anatomical considerations. BJU Int. 1999;84:1113–5.PubMedCrossRef Swinn MJ, Schott GD, Oliver SE, et al. Leg pain after sacral neuromodulation: anatomical considerations. BJU Int. 1999;84:1113–5.PubMedCrossRef
31.
go back to reference Mcgee SM, Routh JC, Granberg CF, et al. Sacral neuromodulation in children with dysfunctional elimination syndrome: description of incisionless first stage and second stage without fluoroscopy. Urology. 2009;73:641–4. discussion 644.PubMedCrossRef Mcgee SM, Routh JC, Granberg CF, et al. Sacral neuromodulation in children with dysfunctional elimination syndrome: description of incisionless first stage and second stage without fluoroscopy. Urology. 2009;73:641–4. discussion 644.PubMedCrossRef
32.
go back to reference Amoroso L, Pelliccioni G, Ghiselli R, et al. Sacral-neuromodulation CT-guided. La Radiologia Medica. 2005;109:421–9.PubMed Amoroso L, Pelliccioni G, Ghiselli R, et al. Sacral-neuromodulation CT-guided. La Radiologia Medica. 2005;109:421–9.PubMed
33.
go back to reference Reitz A, Gobeaux N, Mozer P, et al. Topographic anatomy of a new posterior approach to the pudendal nerve for stimulation. Eur Urol. 2007;51:1350–5. discussion 1355–1356.PubMedCrossRef Reitz A, Gobeaux N, Mozer P, et al. Topographic anatomy of a new posterior approach to the pudendal nerve for stimulation. Eur Urol. 2007;51:1350–5. discussion 1355–1356.PubMedCrossRef
34.
go back to reference Sievert KD, Nagele U, Pannek J, et al. Subcutaneous tunneling of the temporary testing electrode significantly improves the success rate of subchronic sacral nerve modulation (SNM). World J Urol. 2007;25:607–12.PubMedCrossRef Sievert KD, Nagele U, Pannek J, et al. Subcutaneous tunneling of the temporary testing electrode significantly improves the success rate of subchronic sacral nerve modulation (SNM). World J Urol. 2007;25:607–12.PubMedCrossRef
35.
go back to reference Ratto C, Morelli U, Paparo S, et al. Minimally invasive sacral neuromodulation implant technique: modifications to the conventional procedure. Dis Colon Rectum. 2003;46:414–7.PubMedCrossRef Ratto C, Morelli U, Paparo S, et al. Minimally invasive sacral neuromodulation implant technique: modifications to the conventional procedure. Dis Colon Rectum. 2003;46:414–7.PubMedCrossRef
36.
go back to reference Hohenfellner M, Schultz-Lampel D, Dahms S, et al. Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction. J Urol. 1998;160:821–4.PubMedCrossRef Hohenfellner M, Schultz-Lampel D, Dahms S, et al. Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction. J Urol. 1998;160:821–4.PubMedCrossRef
37.
go back to reference Braun PM, Boschert J, Bross S, et al. Tailored laminectomy: a new technique for neuromodulator implantation. J Urol. 1999;162:1607–9.PubMedCrossRef Braun PM, Boschert J, Bross S, et al. Tailored laminectomy: a new technique for neuromodulator implantation. J Urol. 1999;162:1607–9.PubMedCrossRef
38.
go back to reference • Al-Zahrani AA, Elzayat EA, Gajewski JB Long-term outcome and surgical interventions after sacral neuromodulation implant for lower urinary tract symptoms: 14-year experience at 1 center. J Urol. 2011;185:981–6. The efficacy of SNM for different indications is reported for patients treated between 1994 and 2008 with a mean follow-up of 50 months. The authors summarized a good long-term outcome and a reduced reoperation rate due to techical and surgical advances. PubMedCrossRef • Al-Zahrani AA, Elzayat EA, Gajewski JB Long-term outcome and surgical interventions after sacral neuromodulation implant for lower urinary tract symptoms: 14-year experience at 1 center. J Urol. 2011;185:981–6. The efficacy of SNM for different indications is reported for patients treated between 1994 and 2008 with a mean follow-up of 50 months. The authors summarized a good long-term outcome and a reduced reoperation rate due to techical and surgical advances. PubMedCrossRef
39.
go back to reference Marcelissen TA, Leong RK, De Bie RA, et al. Long-term results of sacral neuromodulation with the tined lead procedure. J Urol. 2010;184:1997–2000.PubMedCrossRef Marcelissen TA, Leong RK, De Bie RA, et al. Long-term results of sacral neuromodulation with the tined lead procedure. J Urol. 2010;184:1997–2000.PubMedCrossRef
40.
go back to reference • Kessler TM, Fowler CJ. Sacral neuromodulation for urinary retention. Nature clinical practice. Urology 2008;5:657–66. The authors gave an important and interesting review about the use of SNM for nonobstructive urinary retention. Also, aspects of troubleshooting have been dicussed in this article. PubMed • Kessler TM, Fowler CJ. Sacral neuromodulation for urinary retention. Nature clinical practice. Urology 2008;5:657–66. The authors gave an important and interesting review about the use of SNM for nonobstructive urinary retention. Also, aspects of troubleshooting have been dicussed in this article. PubMed
41.
go back to reference Scheepens WA, Weil EH, Van Koeveringe GA, et al. Buttock placement of the implantable pulse generator: a new implantation technique for sacral neuromodulation–a multicenter study. Eur Urol. 2001;40:434–8.PubMedCrossRef Scheepens WA, Weil EH, Van Koeveringe GA, et al. Buttock placement of the implantable pulse generator: a new implantation technique for sacral neuromodulation–a multicenter study. Eur Urol. 2001;40:434–8.PubMedCrossRef
42.
go back to reference •• Sievert KD, Amend B, Gakis G et al. Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury. Ann Neurol. 2010;67:74–84. The authors investigated the use of SNM in patients with acute spinal cord injury. The development of detrusor overactivity could be prevented by early implantation of bilateral electrodes. Further studies are needed to demonstrate continuing efficacy in this new field of SNM. PubMedCrossRef •• Sievert KD, Amend B, Gakis G et al. Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury. Ann Neurol. 2010;67:74–84. The authors investigated the use of SNM in patients with acute spinal cord injury. The development of detrusor overactivity could be prevented by early implantation of bilateral electrodes. Further studies are needed to demonstrate continuing efficacy in this new field of SNM. PubMedCrossRef
43.
go back to reference Maher MG, Mourtzinos A, Zabihi N, et al. Bilateral caudal epidural neuromodulation for refractory urinary retention: a salvage procedure. J Urol. 2007;177:2237–40. discussion 2241.PubMedCrossRef Maher MG, Mourtzinos A, Zabihi N, et al. Bilateral caudal epidural neuromodulation for refractory urinary retention: a salvage procedure. J Urol. 2007;177:2237–40. discussion 2241.PubMedCrossRef
44.
go back to reference Kaufmann S, Naumann CM, Hamann MF, et al. Unilateral vs bilateral sacral neuromodulation in pigs with formalin-induced detrusor hyperactivity. BJU Int. 2009;103:260–3.PubMedCrossRef Kaufmann S, Naumann CM, Hamann MF, et al. Unilateral vs bilateral sacral neuromodulation in pigs with formalin-induced detrusor hyperactivity. BJU Int. 2009;103:260–3.PubMedCrossRef
45.
go back to reference Scheepens WA, De Bie RA, Weil EH, Van Kerrebroeck PE. Unilateral versus bilateral sacral neuromodulation in patients with chronic voiding dysfunction. J Urol. 2002;168:2046–50.PubMedCrossRef Scheepens WA, De Bie RA, Weil EH, Van Kerrebroeck PE. Unilateral versus bilateral sacral neuromodulation in patients with chronic voiding dysfunction. J Urol. 2002;168:2046–50.PubMedCrossRef
46.
go back to reference Marcelissen TA, Leong RK, Serroyen J, et al. The use of bilateral sacral nerve stimulation in patients with loss of unilateral treatment efficacy. J Urol. 2011;185:976–80.PubMedCrossRef Marcelissen TA, Leong RK, Serroyen J, et al. The use of bilateral sacral nerve stimulation in patients with loss of unilateral treatment efficacy. J Urol. 2011;185:976–80.PubMedCrossRef
47.
go back to reference Pannek J, Grigoleit U, Hinkel A. Bacterial contamination of test stimulation leads during percutaneous nerve stimulation. Urology. 2005;65:1096–8.PubMedCrossRef Pannek J, Grigoleit U, Hinkel A. Bacterial contamination of test stimulation leads during percutaneous nerve stimulation. Urology. 2005;65:1096–8.PubMedCrossRef
48.
go back to reference • Huwyler M, Kiss G, Burkhard FC et al. Microbiological tined-lead examination: does prolonged sacral neuromodulation testing induce infection? BJU Int. 2009;104:646–50; discussion 650. The recommended maximum duration of SNM stimulation ,either by PNE or tined-lead, implantation is still under discussion. The authors investigated prolonged testing and reported equal infection rates compared to "short-term" evaluation. PubMedCrossRef • Huwyler M, Kiss G, Burkhard FC et al. Microbiological tined-lead examination: does prolonged sacral neuromodulation testing induce infection? BJU Int. 2009;104:646–50; discussion 650. The recommended maximum duration of SNM stimulation ,either by PNE or tined-lead, implantation is still under discussion. The authors investigated prolonged testing and reported equal infection rates compared to "short-term" evaluation. PubMedCrossRef
49.
go back to reference Kessler TM, Burkhard FC, Madersbacher H, et al. Safety of prolonged sacral neuromodulation tined lead testing. Curr Med Res Opin. 2008;24:343–7.PubMedCrossRef Kessler TM, Burkhard FC, Madersbacher H, et al. Safety of prolonged sacral neuromodulation tined lead testing. Curr Med Res Opin. 2008;24:343–7.PubMedCrossRef
50.
go back to reference Kessler TM, Madersbacher H. Kiss G Prolonged sacral neuromodulation testing using permanent leads: a more reliable patient selection method? Eur Urol. 2005;47:660–5.PubMedCrossRef Kessler TM, Madersbacher H. Kiss G Prolonged sacral neuromodulation testing using permanent leads: a more reliable patient selection method? Eur Urol. 2005;47:660–5.PubMedCrossRef
51.
go back to reference Sievert KD, Gleason CA, Junemann KP, et al. Physiologic bladder evacuation with selective sacral root stimulation: sinusoidal signal and organ-specific frequency. Neurourol Urodyn. 2002;21:80–91.PubMedCrossRef Sievert KD, Gleason CA, Junemann KP, et al. Physiologic bladder evacuation with selective sacral root stimulation: sinusoidal signal and organ-specific frequency. Neurourol Urodyn. 2002;21:80–91.PubMedCrossRef
52.
go back to reference Fowler CJ, Swinn MJ, Goodwin RJ, et al. Studies of the latency of pelvic floor contraction during peripheral nerve evaluation show that the muscle response is reflexly mediated. J Urol. 2000;163:881–3.PubMedCrossRef Fowler CJ, Swinn MJ, Goodwin RJ, et al. Studies of the latency of pelvic floor contraction during peripheral nerve evaluation show that the muscle response is reflexly mediated. J Urol. 2000;163:881–3.PubMedCrossRef
53.
go back to reference Hijaz A, Vasavada SP, Daneshgari F, et al. Complications and troubleshooting of two-stage sacral neuromodulation therapy: a single-institution experience. Urology. 2006;68:533–7.PubMedCrossRef Hijaz A, Vasavada SP, Daneshgari F, et al. Complications and troubleshooting of two-stage sacral neuromodulation therapy: a single-institution experience. Urology. 2006;68:533–7.PubMedCrossRef
54.
go back to reference Mahfooz AB, Elmayergi N, Abdelhady M, et al. Parameters of successful sacral root neuromodulation of the pelvic floor: a retrospective study. Can J Urol. 2004;11:2303–8.PubMed Mahfooz AB, Elmayergi N, Abdelhady M, et al. Parameters of successful sacral root neuromodulation of the pelvic floor: a retrospective study. Can J Urol. 2004;11:2303–8.PubMed
55.
go back to reference Seif C, Herzog J, Van Der Horst C, et al. Effect of subthalamic deep brain stimulation on the function of the urinary bladder. Ann Neurol. 2004;55:118–20.PubMedCrossRef Seif C, Herzog J, Van Der Horst C, et al. Effect of subthalamic deep brain stimulation on the function of the urinary bladder. Ann Neurol. 2004;55:118–20.PubMedCrossRef
56.
go back to reference •• Fowler CJ, Griffiths DJ. A decade of functional brain imaging applied to bladder control. Neurourol Urodyn. 2010;29:49–55. Less is known about the neurophysiological background of SNM. Functional-imaging techniques facilitate insights into the complex neuronal network. The authors presented an excellent review on the current state and future possibilities of functional-imaging techniques to investigate lower urinary innervations. PubMed •• Fowler CJ, Griffiths DJ. A decade of functional brain imaging applied to bladder control. Neurourol Urodyn. 2010;29:49–55. Less is known about the neurophysiological background of SNM. Functional-imaging techniques facilitate insights into the complex neuronal network. The authors presented an excellent review on the current state and future possibilities of functional-imaging techniques to investigate lower urinary innervations. PubMed
Metadata
Title
How Does Sacral Modulation Work Best? Placement and Programming Techniques to Maximize Efficacy
Authors
Bastian Amend
Mahmoud Khalil
Thomas M. Kessler
Karl-Dietrich Sievert
Publication date
01-10-2011
Publisher
Current Science Inc.
Published in
Current Urology Reports / Issue 5/2011
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-011-0204-2

Other articles of this Issue 5/2011

Current Urology Reports 5/2011 Go to the issue