MP89-11 CT-GUIDED SACRAL NEUROMODULATION S3 - A NEW TARGETED APPROACH AFTER INITIAL TREATMENT FAILURE: THE FIRST 10 PATIENTS

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-Neurogenic Voiding Dysfunction1 Apr 2015MP89-11 CT-GUIDED SACRAL NEUROMODULATION S3 - A NEW TARGETED APPROACH AFTER INITIAL TREATMENT FAILURE: THE FIRST 10 PATIENTS Sophina Trubel, Elena Esra Foditsch, Günter Janetschek, and Reinhold Posch-Zimmermann Sophina TrubelSophina Trubel More articles by this author , Elena Esra FoditschElena Esra Foditsch More articles by this author , Günter JanetschekGünter Janetschek More articles by this author , and Reinhold Posch-ZimmermannReinhold Posch-Zimmermann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1810AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Insertion of tined lead electrodes through the neuroforamen to the sacral root S3 under fluoroscopy is established for Sacral Neuromodulation (SNM). This approach is not feasible in some patients due to anatomic abnormalities. Our trial is to evaluate a Computed tomography (CT) - guided SNM procedure as a more targeted approach for electrode placement in patients who fail with the standard procedure. METHODS We included 10 patients (7 female, 3 male, mean age 47a). Indications for SNM were overactive bladder (3), retention (4), retention due to meningomyelocele (3). In 5 patients conventional puncture failed primarily, one patient was considered to be not accessible for conventional SNM due to trauma and in four patients an intraoperative positioning control was required due to electrode dislocation after initially successful SNM. The individual anatomy and the subsequent “roadmap” were figured out by an initial planning CT. CT- guided S3 approach itself was conducted in local anaesthesia by sequential scanning of the needle insertion. Once the nerve was reached according to CT criteria, the clinical response was evaluated. If an adequate stimulation result was confirmed, the electrodes were implanted again under CT guidance using the standard tools via guide wire. Further clinical evaluation was according to our standard protocol. RESULTS Bilateral S3 nerve root could be well identified by CT in all cases. CT-guided S3 access and an adequate clinical response could be obtained. The needed stimulation parameters were comparatively low. All patients were implanted bilaterally due to the specific clinical set up. Operation time was between 45 – 90 minutes. All but one patients underwent definitive IPG implantation after a successful clinical trial according to our standard criteria. No short/long term complications were observed. CONCLUSIONS CT-guided sacral neuromodulation (S3) offers a reliable and safe option for patients who are not suitable for or fail SNM under fluoroscopy due to anatomical complexity like menigomyelocele, narrow neuroforamina or following a trauma. The precise imaging might increase response rate and improve clinical effects. Long term SNM efficiacy might be increased by lower stimulation parameters needed after CT SNM. It might even be considered for patients with SNM failure after initial effectiveness. We will evaluate the stimulation parameters closely on the long run and evaluate more patients not suitable for the conventional SNM to prove this approach for new indications. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1104 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sophina Trubel More articles by this author Elena Esra Foditsch More articles by this author Günter Janetschek More articles by this author Reinhold Posch-Zimmermann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...