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International Urogynecology Journal

Erschienen in:

08.01.2021 | IUJ Video

Sacral neuromodulation: troubleshooting needle placement

verfasst von: Whitney K. Hendrickson, Cindy L. Amundsen

Erschienen in: International Urogynecology Journal | Ausgabe 9/2021

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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.

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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

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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

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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.

Titel: Sacral neuromodulation: troubleshooting needle placement
verfasst von: Whitney K. Hendrickson
Cindy L. Amundsen
Publikationsdatum: 08.01.2021
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 9/2021
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04614-9

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Sacral neuromodulation: troubleshooting needle placement

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Introduction and hypothesis

Methods

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Conclusions

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