Skip to main content

Sacral neuromodulation: troubleshooting needle placement

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.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Goldman HB, Lloyd JC, Noblett KL, Carey MP, Castaño Botero JC, Gajewski JB, et al. International Continence Society best practice statement for use of sacral neuromodulation. Neurourol Urodyn. 2018;37(5):1823–48. https://doi.org/10.1002/nau.23515.

    Article  PubMed  Google Scholar 

  2. 2.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    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.

    Article  PubMed  Google Scholar 

  4. 4.

    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.

    Article  PubMed  Google Scholar 

  5. 5.

    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;36(4):1136–9. https://doi.org/10.1002/nau.23076.

    Article  PubMed  Google Scholar 

  6. 6.

    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.

    Article  Google Scholar 

  7. 7.

    Govaert B, Melenhorst J, van Gemert WG, Baeten CG. Can sensory and/or motor reactions during percutaneous nerve evaluation predict outcome of sacral nerve modulation? Dis Colon Rectum. 2009;52(8):1423–6. https://doi.org/10.1007/DCR.0b013e3181a91241.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Siegel S, Noblett K, Mangel J, Bennett J, Griebling TL, Sutherland SE, et al. Five-year follow up results of a prospective, multicenter study of patients with overactive bladder treated with sacral neuromodulation. J Urol. 2018;199(1):229–36. https://doi.org/10.1016/j.juro.2017.07.010.

    Article  PubMed  Google Scholar 

  9. 9.

    Cohn JA, Kowalik CG, Kaufman MR, Reynolds WS, Milam DF, Dmochowski RR. Evaluation of the axonics modulation technologies sacral neuromodulation system for the treatment of urinary and fecal dysfunction. Exp Rev Med Dev. 2017;14(1):3–14. https://doi.org/10.1080/17434440.2017.1268913.

    CAS  Article  Google Scholar 

  10. 10.

    Chai TC, Mamo GJ. Modified techniques of S3 foramen localization and lead implantation in S3 neuromodulation. Urology. 2001;58:786–90. https://doi.org/10.1016/s0090-4295(01)01326-7.

    CAS  Article  PubMed  Google Scholar 

  11. 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.

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Whitney K. Hendrickson.

Ethics declarations

Conflicts of interest

The Authors declare that they have no conflicts of interest. The components used in this video were previously provided to the department for educational purposes by Medtronic® (Minneapolis, MN, USA).

Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

(MP4 34486 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hendrickson, W.K., Amundsen, C.L. Sacral neuromodulation: troubleshooting needle placement. Int Urogynecol J 32, 2549–2551 (2021). https://doi.org/10.1007/s00192-020-04614-9

Download citation

Keywords

  • Sacral neuromodulation
  • Sacral neurostimulation
  • Optimal lead placement
  • Overactive bladder
  • Urgency incontinence
  • Fecal incontinence
  • Urinary retention