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Computed tomography-guided S3 lead placement for sacral neuromodulation.

Christopher P Chung1, Paul A Neese, Hoang Kim Le

  • 1Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Scott and White Healthcare, Texas A&M Health Science Center College of Medicine, 2401 South 31st Street, Temple, TX 76508, USA. cchung@swmail.sw.org

International Urogynecology Journal
|May 17, 2012
PubMed
Summary

Computed tomography (CT)-guided sacral neuromodulation effectively treated urinary symptoms in a patient with challenging anatomy. CT guidance enabled precise lead placement, overcoming limitations of traditional fluoroscopy for improved patient outcomes.

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Area of Science:

  • Neurology
  • Urology
  • Medical Imaging

Background:

  • Sacral neuromodulation is a treatment for lower urinary tract dysfunction.
  • Anatomical challenges like narrow S3 foramina can complicate lead placement.
  • Conventional fluoroscopy may be insufficient for precise S3 foramina localization.

Observation:

  • Computed tomography (CT) was utilized for precise guidance during lead placement for sacral neuromodulation.
  • The procedure involved localizing bilateral S3 foramina and placing guide needles under CT guidance.
  • A tined, quadripolar lead was successfully implanted through a dilated S3 tract.

Findings:

  • CT guidance facilitated accurate localization of bilateral S3 foramina, even in cases where fluoroscopy failed.
  • The patient experienced over 50% improvement in urinary symptoms, confirmed by voiding diary.

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  • Lead placement was optimized through interrogation to determine the superior lead response.

    • Implications:

    • CT-guided sacral neuromodulation offers a viable solution for patients with complex anatomy.
    • This technique enhances the success rate of sacral neuromodulation in challenging cases.
    • Improved lead placement accuracy can lead to better symptom management and patient quality of life.