Removal of Sacral Neuromodulation Devices Is an Office Procedure

Abstract

In some instances, sacral neuromodulation (SNM) devices need to be removed. Traditionally, permanent lead and/or implantable pulse generator (IPG) removals are done in the operating room under sedation. Our objective is to present our experience removing SNM components under local in the office. We performed a retrospective chart review from 2017-2022 of SNM lead and IPG removals performed under local anesthesia in the office by a single surgeon. Patient characteristics, outcomes and complications were reported. From 2017-2022 41 SNM leads with and without IPGs were removed in the office using local anesthesia. 88% were female, mean age 66 ± 15.8 years, and mean BMI 28.6 (19.1-49.4). The most common indications for SNM treatment were urgency incontinence (56%) and non-obstructive urinary retention (24%). 44% (18/41) of SNM device removals were leads removed after failed stage I and 56% (23/41) were leads with IPGs removed most commonly for decreased efficacy (52%). In the latter group, median time to removal was 3.1 (0.3-12.3) years, and 52% (12/23) required a separate medial incision for lead retrieval. 9% (2/23) required fluoroscopy, of which, one was planned secondary to BMI 49.4, and the other needed secondary to excessive scar tissue. No stage I failures required fluoroscopy. 7% (3/41) of leads required cutdown to the sacrum for removal with leads in place between 3.1-3.9 years. All leads were removed completely intact and there were no complications. Removal of SNM devices in the office using local anesthesia is effective, well-tolerated, and safe.