Top

International Urogynecology Journal

Published in:

01-09-2021 | Overactive Bladder | IUJ Video

Sacral neuromodulation: troubleshooting needle placement

Authors: Whitney K. Hendrickson, Cindy L. Amundsen

Published in: International Urogynecology Journal | Issue 9/2021

Abstract

Introduction and hypothesis

The objective was to develop an instructional video that utilizes fluoroscopic images and anatomical landmarks to increase the surgeon’s ability to troubleshoot optimal placement of the foramen needle and lead during a stage I sacral neuromodulation (SNM) procedure.

Methods

Eight different examples of suboptimal foramen needle placement with subsequent corrections during a SNM procedure were performed and recorded on a fresh female cadaver.

Results

Fluoroscopic images were obtained during the procedure, and illustrations of the posterior aspect of the sacrum highlighting the S3 foramina and nerve are shown for anatomical comparison.

Conclusions

This video demonstrates how to efficiently identify and correct suboptimal foramen needle placement in order to obtain optimal lead placement during an SNM procedure. Understanding the relationship between the bony landmarks on fluoroscopy and the S3 nerve and foramen are important in order to understand how to correct a suboptimal foramen needle and thus achieve optimal lead placement.

Available only for authorised users

Goldman HB, Lloyd JC, Noblett KL, Carey MP, Castaño Botero JC, Gajewski JB, et al. International Continence Society best practice statement for use of sacral neuromodulation. Neurourol Urodyn. 2018;37(5):1823–48. https://doi.org/10.1002/nau.23515.CrossRefPubMed

Amundsen CL, Komesu YM, Chermansky C, Gregory WT, Myers DL, Honeycutt EF, et al. Two-year outcomes of sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: a randomized trial. Eur Urol. 2018;74(1):66–73. https://doi.org/10.1016/j.eururo.2018.02.011.CrossRefPubMedPubMedCentral

Hull T, Giese C, Wexner SD, Mellgren A, Devroede G, Madoff RD, et al. Long-term durability of sacral nerve stimulation therapy for chronic fecal incontinence. Dis Colon Rectum. 2013;56(2):234–45. https://doi.org/10.1097/DCR.0b013e318276b24c.CrossRefPubMed

Pizarro-Berdichevsky J, Gill BC, Clifton M, Okafor HT, Faris AE, Vasavada SP, et al. Motor response matters: optimizing lead placement improves sacral neuromodulation outcomes. J Urol. 2018;199(4):1032–6. https://doi.org/10.1016/j.juro.2017.11.066.CrossRefPubMed

Noblett K, Benson K, Kreder K. Detailed analysis of adverse events and surgical interventions in a large prospective trial of sacral neuromodulation therapy for overactive bladder patients. Neurourol Urodyn. 2017;36(4):1136–9. https://doi.org/10.1002/nau.23076.CrossRefPubMed

Harvie HS, Amundsen CL, Neuwahl SJ, Honeycutt AA, Lukacz ES, Sung VW, et al. Cost effectiveness of sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: results of the ROSETTA randomized trial. J Urol. 2019;18:969–77. https://doi.org/10.1097/JU.0000000000000656.CrossRef

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(8):1423–6. https://doi.org/10.1007/DCR.0b013e3181a91241.CrossRefPubMed

Siegel S, Noblett K, Mangel J, Bennett J, Griebling TL, Sutherland SE, et al. Five-year follow up results of a prospective, multicenter study of patients with overactive bladder treated with sacral neuromodulation. J Urol. 2018;199(1):229–36. https://doi.org/10.1016/j.juro.2017.07.010.CrossRefPubMed

Cohn JA, Kowalik CG, Kaufman MR, Reynolds WS, Milam DF, Dmochowski RR. Evaluation of the axonics modulation technologies sacral neuromodulation system for the treatment of urinary and fecal dysfunction. Exp Rev Med Dev. 2017;14(1):3–14. https://doi.org/10.1080/17434440.2017.1268913.CrossRef

10.

Chai TC, Mamo GJ. Modified techniques of S3 foramen localization and lead implantation in S3 neuromodulation. Urology. 2001;58:786–90. https://doi.org/10.1016/s0090-4295(01)01326-7.CrossRefPubMed

11.

Hendrickson WK, Amundsen CL. Sacral neuromodulation: sacral anatomy and optimal lead placement. Int Urogynecol J. 2020. https://doi.org/10.1007/s00192-020-04615-8.

Title: Sacral neuromodulation: troubleshooting needle placement
Authors: Whitney K. Hendrickson
Cindy L. Amundsen
Publication date: 01-09-2021
Publisher: Springer International Publishing
Keywords: Overactive Bladder
Fecal Incontinence
Nerve Stimulation
Published in: International Urogynecology Journal / Issue 9/2021
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04614-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Sacral neuromodulation: troubleshooting needle placement

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2021

Evaluation of mobile applications for patients with fecal incontinence using a modified APPLICATIONS scoring system

Vaginal repair of nonradiogenic urogenital fistulas

Obstetric anal sphincter injury following previous vaginal delivery

Evaluation of surgical approaches for vesicovaginal fistulae repair: the case for transvaginal repair as the gold standard

Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Forceps and vacuum: one goal, two entities