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Computed Tomography-Guided Placement of Sacral Electrodes
Ada Rosen1,2, Sorin Elias3,2, Hadas Ganer Herman4,2
1Department of Surgery A and Proctology, Wolfson Medical Center, Holon, Israel.
Background:
The current approach to performing sacral neuromodulation consists of a two-stage procedure, the first of which includes insertion of the sacral electrode under fluoroscopic visualization of the S3 foramen. Alternatively, in certain situations computed tomography (CT)-guided insertion can be used.
Objectives:
To evaluate the use of CT in cases of reinsertion of the electrode due to infection, dislocation, or rupture.
Methods:
Medical records of patients who underwent neuromodulation device reinsertion between 2005 and 2016 for fecal incontinence were reviewed. Study outcomes included procedure course, successful placement, and long-term treatment success.
Results:
During the study period, we inserted a neuromodulation device in 67 patients. A CT-guided insertion of a sacral electrode was performed in 10 patients. In nine patients, the insertion and the final location of the electrode were successful. In one patient, the electrode migrated upward due to a malformation of the S3 foramen on both sides and had to be placed in S4. In a mean follow-up of 68.4 ± 30.0 months following the re-insertion, there was a significant reduction in the number of incontinence episodes per day (P < 0.001) and the number of pads used per day (P = 0.002).
Conclusions:
CT-guided insertion of a sacral electrode is a safe and promising option, especially in recurrent and or selected cases.
