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Sacral Neuromodulation Lead Twisting Causes Migration and Loss of Efficacy
Juan M Guzman-Negron1, Samir Derisavifard, Howard B Goldman
1From the Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
Objective:
This study aimed to present 2 cases with unusual lead complications in InterStim devices implanted in patients with refractory overactive bladder symptoms.
Materials:
Two patients with InterStim implants presented with loss of efficacy. Both patients required lead revision surgery with findings of a twisted lead with associated lead migration.
Results:
In both cases, revision surgery revealed twisting of the InterStim lead causing retrograde lead displacement. Patients were managed with lead removal and placement of a new lead. At the time of revision, one patient had a seroma within a large pocket of the implantable pulse generator (IPG) site, which was managed with closure and development of a new IPG pocket. In both cases, revision with new lead placement resulted in significant symptom improvement.
Conclusions:
Sacral neuromodulation lead complications are known to be among the most consequential adverse events. We report the first 2 cases, to our knowledge, of patients presenting with an InterStim device that lost efficacy due to lead twisting and subsequent retrograde lead migration, likely due to rotation of the IPG within the gluteal pocket. This finding is easily remedied with IPG pocket revision and lead replacement.
