V2-10 IDENTIFICATION OF THE S3 FORAMEN DURING TRANSFORAMINAL SACRAL NEUROMODULATION LEAD PLACEMENT – A NOVEL “ROLLING PEN” TECHNIQUE

Abstract

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-10 IDENTIFICATION OF THE S3 FORAMEN DURING TRANSFORAMINAL SACRAL NEUROMODULATION LEAD PLACEMENT – A NOVEL “ROLLING PEN” TECHNIQUE Amanda Saltzman, Kristi Hebert, Howard Woo, and Ryan Krlin Amanda SaltzmanAmanda Saltzman More articles by this author , Kristi HebertKristi Hebert More articles by this author , Howard WooHoward Woo More articles by this author , and Ryan KrlinRyan Krlin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.335AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral neuromodulation (SNM) is FDA approved for urinary urgency, urinary frequency, urgency urinary incontinence, non-obstructive urinary retention and fecal incontinence. SNM modulates electrical input to the bladder preventing and decreasing over stimulation, thus improving symptoms. The S3 foramen must be localized for lead implantation and the efficacy of implantation depends on the ability to localize S3 reliably and correctly. Localization is accomplished using various strategies, most commonly using a combination of palpation of bony landmarks and fluoroscopy. This paper will serve to introduce a novel “rolling pen” technique that eliminates the use of fluoroscopy for S3 identification. This technique is currently used in clinical practice by the two highest volume implanters in Louisiana. METHODS The patients were positioned prone and prepped in the usual manner. Instead of using fluoroscopy or palpation to identify bony landmarks to localize the S3 foramen, we balanced a marking pen longitudinally in the midline of the sacrum. The pen was allowed to roll until horizontal equilibrium was established. The fulcrum of the balanced “rolling pen” identified the level of S3. A mark 2 cm proximal and 2 cm lateral to this landmark was made for entry of the finder needle at the level of the skin. We then proceeded with our implantation in the usual manner. The rolling pen technique was used for all patients as our initial strategy to identify the S3 foramen. RESULTS 228 implantations were performed between 7/2012 and 10/2014 at our 2 tertiary centers. All cases used the rolling pen technique as our initial S3 foramen identification strategy. Adhering to the ALARA principle, fluoroscopy was limited to confirming and adjusting needle and lead placement in the operating room. All office procedures were performed without fluoroscopy. CONCLUSIONS We conclude that the novel rolling pen technique can be used as yet another method for S3 localization during transforaminal lead placement during SNM implantation. This decreases radiation exposure and likely cost. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e100 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Saltzman More articles by this author Kristi Hebert More articles by this author Howard Woo More articles by this author Ryan Krlin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...