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Radiation exposure during sacral neuromodulation lead placement: Multi-institutional descriptive study.

Ramzy T Burns1, Joanna Orzel2, Paul Wadensweiler3

  • 1Department of Urology, Indiana University, Indianapolis, Indiana, USA.

Neurourology and Urodynamics
|February 6, 2024
PubMed
Summary

Sacral neuromodulation (SNM) procedures show wide variation in fluoroscopy time and radiation dose. Factors like institution and surgeon volume impact exposure, highlighting a need for standardized protocols to minimize risks.

Keywords:
electric stimulation therapyfluoroscopyionizingoveractiveradiationradiologysurgeonsurinary bladderurology

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Area of Science:

  • Urology
  • Neurosurgery
  • Minimally Invasive Surgery

Background:

  • Fluoroscopy enhances sacral neuromodulation (SNM) lead placement and reduces surgical duration.
  • Limited data exists on fluoroscopy's radiation exposure and safety during SNM procedures.

Purpose of the Study:

  • To analyze fluoroscopy time and radiation dose in SNM surgeries across multiple institutions.
  • To identify predictors of increased fluoroscopy time and radiation dose during SNM procedures.

Main Methods:

  • Retrospective review of 664 SNM procedures (Stage 1 and full implant) from 2016-2021 at four academic centers.
  • Collected demographic, clinical, and intraoperative data, including fluoroscopy time and radiation dose (mGy).
  • Performed univariate and multivariate analyses to identify predictive factors for radiation exposure.

Main Results:

  • Significant variability in fluoroscopy time and dose was observed across institutions and surgical specialties.
  • Bilateral finder needle testing, surgical indication, surgeon volume, and institution were significant predictors of increased fluoroscopy time and radiation dose (p < 0.05).
  • Most procedures (79.6%) were performed by Female Pelvic Medicine and Reconstructive Surgery specialists, with 76.4% of surgeons being low-volume implanters.

Conclusions:

  • Substantial variability exists in fluoroscopy utilization during SNM procedures.
  • Increased radiation exposure poses risks to surgical teams and patients.
  • Standardization of fluoroscopy use in SNM procedures is necessary to mitigate potential harm.