Prospective randomized study evaluating ultrasound versus fluoroscopy guided sacral InterStim® lead placement: A...

Area of Science:

• Urology
• Medical Imaging
• Neurosurgery

Background:

• Sacral neuromodulation is a treatment for refractory overactive bladder and fecal incontinence.
• Current lead placement relies on fluoroscopy, involving radiation exposure.
• Minimizing radiation is crucial for patient and staff safety.

Purpose of the Study:

• To evaluate the efficacy of intraoperative ultrasound guidance for Stage I InterStim® sacral lead placement.
• To compare ultrasound-guided placement with traditional fluoroscopy-guided placement.

Main Methods:

• A randomized controlled trial involving 40 patients with refractory overactive bladder, fecal incontinence, or both.
• Patients were assigned to either ultrasound or fluoroscopy guidance for InterStim® lead placement.
• Primary endpoint was fluoroscopy time; secondary endpoints included radiation exposure and needle punctures.

Main Results:

• Ultrasound guidance significantly reduced radiation exposure time (by 70.5s) and radiation dose (by 42.3 mGy).
• The number of needle skin punctures decreased by 3.6 with ultrasound guidance.
• No significant differences were observed in operating room time or patient-reported outcomes between the groups.

Conclusions:

• Intraoperative ultrasound guidance for sacral lead placement effectively reduces radiation exposure for patients and staff.
• Further research is needed to establish the learning curve and long-term efficacy of this technique.