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Post-Implant Management of Sacral Neuromodulation

  • Overactive Bladder and Lower Urinary Tract Symptoms (U Lee and S Adelstein, Section Editors)
  • Published:
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Abstract

Purpose of Review

Post-implant management of sacral neuromodulation is crucial in ensuring the success of therapy. Common management dilemmas include various follow-up schedules, circumstances related to pregnancy, and the possible need for magnetic resonance imaging. Moreover, complications such as lack of or declining efficacy over time, painful stimulation, pain at the implantable pulse generator site, and wound complications need to properly be handled.

Recent Findings

In this chapter, each of these above-mentioned scenarios is explored, and the literature concerning them is reviewed. Tips regarding dealing with management dilemmas and practical resolutions of complications are discussed.

Summary

In this review, we have given a combination of analysis from the literature and practical suggestions based on years of experience in providing SNM therapy. These tips should be helpful in getting the best result after appropriate patient selection and implant technique have been employed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wexner SD, Coller JA, Devroede G, Hull T, McCallum R, Chan M, et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010;251:441–9.

    Article  PubMed  Google Scholar 

  2. Gilleran JP, Killinger K, Boura J, Peters KM. Number of active electrodes at time of staged tined lead interstim implant does not impact clinical outcomes. Neurourol Urodyn. 2016;35:625–9.

    Article  PubMed  Google Scholar 

  3. Siddiqui NY, Amundsen CL, Corey EG, Wu JM. Lead migration after sacral neuromodulation: surgical revision in fascial versus tined anchoring systems. Int Urogynecol J. 2011;22:419–23.

    Article  PubMed  Google Scholar 

  4. Roulette, P., Castel-Lacanal, E., Sanson, S. et al.. Sacral neuromodulation and pregnancy: results of a national survey carried out for the neuro-urology committee of the French Association of Urology (AFU). Neurourol Urodyn, 2017. https://www.yourpelvicfloor.org/media/sacral-neuromodulation-english.pdf.

  5. International Urogynecological Association, Patient information: leaflets and brochures, sacral neuromodulation: a guide for women, 2013. Retrieved March 8, 2016, from http://c.ymcdn.com/sites/www. iuga.org/resource/resmgr/leaflet/Sacral_Neuromodulation.pdf.

  6. Medtronic. Indications insert Medtronic InterStim therapy. Retrieved March 8, 2016, from http://manuals.medtronic.com/ content/dam/emanuals/neuro/CONTRIB_087797.pdf.

  7. Karsdon J, Garfield RE, Shi SQ, Maner W, Saade G. Electrical inhibition of preterm birth: inhibition of uterine contractility in the rabbit and pup births in the rat. Am J Obstet Gynecol. 2005;193:1986–93.

    Article  PubMed  Google Scholar 

  8. Kothari TH, Maner WL, Shi SQ, Garfield RE, Chen JDZ. Inhibitory effects of electrical stimulation on delivery in pregnant rats. Eur J Obstet Gynecol Reprod Biol. 2008;141:18–22.

    Article  PubMed  Google Scholar 

  9. Fujii O, Murakami T, Murakawa H, Terada Y, Ogura T, Yaegashi N. Uterine relaxation by sacral surface electrical stimulation on the day of embryo transfer. Fertil Steril. 2008;90:1240–2.

    Article  PubMed  Google Scholar 

  10. El-Khawand D, Montgomery OC, Wehbe SA, et al. Sacral nerve stimulation during pregnancy: case report and review of the literature. Female Pelvic Med Reconstr Surg. 2012;18:127–9.

    Article  PubMed  Google Scholar 

  11. Mahran A, Soriano A, Safwat AS, Hijaz A, Mahajan ST, Trabuco EC, et al. The effect of sacral neuromodulation on pregnancy: a systematic review. Int Urogynecol J. 2017;28:1357–65.

    Article  PubMed  Google Scholar 

  12. Wang Y, Hassouna MM. Electrical stimulation has no adverse effect on pregnant rats and fetuses. J Urol. 1999;162:1785–7.

    Article  PubMed  CAS  Google Scholar 

  13. •• Yaiesh SM, Al-Terki AE, Al-Shaiji TF. Safety of sacral nerve stimulation in pregnancy: a literature review. Neuromodulation. 2016. A literature review on SNM and pregnancy. They concluded that there were no clear identified adverse effects on the fetus, mother, or device.;19:770–9.

    Article  PubMed  Google Scholar 

  14. Goldenberg RL, Culhane JF, Johnson DC. Maternal infection and adverse fetal and neonatal outcomes. Clin Perinatol. 2005;32:523–59.

    Article  PubMed  Google Scholar 

  15. Russo RJ, Costa HS, Silva PD, Anderson JL, Arshad A, Biederman RWW, et al. Assessing the risks associated with MRI in patients with a pacemaker or defibrillator. N Engl J Med. 2017;376:755–64.

    Article  PubMed  Google Scholar 

  16. Elkelini MS, Hassouna MM. Safety of MRI at 1.5Tesla in patients with implanted sacral nerve neurostimulator. Eur Urol. 2006;50:311–6.

    Article  PubMed  Google Scholar 

  17. Chermansky CJ, Krlin RM, Holley TD, Woo HH, Winters JC. Magnetic resonance imaging following InterStim(R): an institutional experience with imaging safety and patient satisfaction. Neurourol Urodyn. 2011;30:1486–8.

    Article  PubMed  Google Scholar 

  18. • Quirouet A, Bhattacharyya PK, Dielubanza EJ, Gill BC, Jones SE, Goldman HB. Sacral neuromodulation device heating during lumbar and pelvic magnetic resonance imaging—a phantom study. Urology. 2017. A Cleveland Clinic study used an SNM model to study the effects of MRI. There was an acceptable rise with the intact device and with a truncated distal lead. However, there was a worrisome temperature rise when an intact lead was studied.;107:61–6.

    Article  PubMed  Google Scholar 

  19. Siegel S, Noblett K, Mangel J, Griebling TL, Sutherland SE, Bird ET, et al. Three-year follow-up results of a prospective, multicenter study in overactive bladder subjects treated with sacral neuromodulation. Urology. 2016;94:57–63.

    Article  PubMed  Google Scholar 

  20. Van Voskuilen AC, Oerlemans DJ, Weil EH, et al. Medium-term experience of sacral neuromodulation by tined lead implantation. BJU Int. 2007;99:107–10.

    Article  PubMed  Google Scholar 

  21. Guralnick ML, Benouni S, O’Connor RC, et al. Characteristics of infections in patients undergoing staged implantation for sacral nerve stimulation. Urology. 2007;69:1073–6.

    Article  PubMed  Google Scholar 

  22. Siegel SW, Catanzaro F, Dijkema HE, Elhilali MM, Fowler CJ, Gajewski JB, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology. 2000;56:87–91.

    Article  PubMed  CAS  Google Scholar 

  23. •• Carmel ME, Vasavada SP, Goldman HB. Troubleshooting sacral neuromodulation issues. Curr Urol Rep. 2012. Excellent problem-based approach to post-implant complications related to SNM.;13:363–9.

    Article  PubMed  Google Scholar 

  24. • Ismail S, Chartier-Kastler E, Perrouin-Verbe MA, Rose-Dite-Modestine J, Denys P, Phé V. Long-term functional outcomes of S3 sacral neuromodulation for the treatment of idiopathic overactive bladder. Neuromodulation. 2017. A long-term retrospecitive anlaysis of a French tertiary care center reporting a 63% efficacy rate for the treatment of refractory OAB.;20:825–9.

    Article  PubMed  Google Scholar 

  25. Peters KM, Killinger KA, Gilleran JP, Bartley J, Wolfert C, Boura JA. Predictors of reoperation after sacral neuromodulation: a single institution evaluation of over 400 patients. Neurourol Urodyn. 2017;36:354–9.

    Article  PubMed  Google Scholar 

  26. Hijaz A, Vasavada S. Complications and troubleshooting of sacral neuromodulation therapy. Urol Clin N Am. 2005;32:65–9.

    Article  Google Scholar 

  27. Hijaz A, Vasavada SP, Daneshgari F, Frinjari H, Goldman H, Rackley R. Complications and troubleshooting of two-stage sacral neuromodulation therapy: a single-institution experience. Urology. 2006;68:533–7.

    Article  PubMed  Google Scholar 

  28. Pettit P. Current opinion: complications and troubleshooting of sacral neuromodulation. Int Urogynecol J. 2010;21 Suppl 2:S491.

    Article  PubMed  Google Scholar 

  29. •• Liberman D, Ehlert MJ, Siegel SW. Sacral neuromodulation in urological practice. Urology. 2017. A review of the literature for approved and expanding indications for SNM as well as methods to optimize lead placement.;99:14–22.

    Article  PubMed  Google Scholar 

  30. Uludag O, Koch SM, van Gemert WG, et al. Sacral neuromodulation in patients with fecal incontinence: a single-center study. Dis Colon Rectum. 2004;47:1350–7.

    Article  PubMed  Google Scholar 

  31. •• 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. Using the InSite trial, a 30% rate of adverse events at 12 months was described whereby most complications were minor and addressed without surgical intervention.;36:1136–9.

    Article  PubMed  Google Scholar 

  32. • Lee C, Pizarro-Berdichevsky J, Clifton MM, Vasavada SP. Sacral neuromodulation implant infection: risk factors and prevention. Curr Urol Rep. 2017. A literature review of risk factors associated with SNM infection and outline protocols for infection prevention.;18(16):16.

    Article  PubMed  Google Scholar 

  33. Wexner SD, Hull T, Edden Y, Coller JA, Devroede G, McCallum R, et al. Infection rates in a large investigational trial of sacral nerve stimulation for fecal incontinence. J Gastrointest Surg. 2010;14:1081–9.

    Article  PubMed  Google Scholar 

  34. Lai HH, Grewal S. Bacterial colonization rate of InterStim and infection outcome with staged testing. Urology. 2013;82:1255–60.

    Article  PubMed  Google Scholar 

  35. Amend B, Bedke J, Khalil M, Stenzl A, Sievert KD. Prolonged percutaneous SNM testing does not cause infection-related explanation. BJU Int. 2013;111:485–91.

    Article  PubMed  Google Scholar 

  36. Siegel S. Complications of female incontinence and pelvic reconstructive surgery. In: Goldman H, editor. Complications of female incontinence and pelvic reconstructive surgery. Second ed. Cham: Springer Nature; 2017. p. 307–16.

    Chapter  Google Scholar 

  37. Haraway AM, Clemens JQ, He C, Stroup C, Atiemo HO, Cameron AP. Differences in sacral neuromodulation device infection rates based on preoperative antibiotic selection. Int Urogynecol J. 2013;24:2081–5.

    Article  PubMed  Google Scholar 

  38. Scheepens WA, Weil EH, van Koeveringe GA, et al. Buttock placement of the implantable pulse generator: a new implantation technique for sacral neuromodulation—a multicenter study. Eur Urol. 2001;40:434–8.

    Article  PubMed  CAS  Google Scholar 

  39. Everaert K, De Ridder D, Baert L, et al. Patient satisfaction and complications following sacral nerve stimulation for urinary retention, urge incontinence and perineal pain: a multicenter evaluation. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:231–6.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Urology, University of Montreal Health Center (CHUM), Montreal, Canada

    Daniel Liberman

  2. Metro Urology Center for Continence Care and Female Urology, St. Paul, MN, USA

    Steven W. Siegel

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  1. Daniel Liberman
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  2. Steven W. Siegel
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Corresponding author

Correspondence to Steven W. Siegel.

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Conflict of Interest

Daniel Liberman declares that he has no conflict of interest.

Dr. Siegel declares grants and personal fees from Medtronic, personal fees from NuVectra, grants and personal fees from Allergan, grants and personal fees from FemPulse, personal fees from Avodel, outside the submitted work, and Ad board member, research and grant support for products related to neuromodulation, proctorship/lecture fees.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Overactive Bladder and Lower Urinary Tract Symptoms

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Liberman, D., Siegel, S.W. Post-Implant Management of Sacral Neuromodulation. Curr Bladder Dysfunct Rep 13, 139–144 (2018). https://doi.org/10.1007/s11884-018-0475-2

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  • DOI: https://doi.org/10.1007/s11884-018-0475-2

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