Failure of sacral nerve stimulation due to migration of tined lead
Failure of sacral nerve stimulation due to migration of tined lead
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DOI：
10.1016/s0022-5347(06)00318-1
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发表时间：
2006-06-01
影响因子：
6.6
通讯作者：
Rodriguez, Larissa V.
中科院分区：
文献类型：
--
作者：
Deng, Donna Y.;Gulati, Mittul;Rodriguez, Larissa V.
目的：骶神经刺激是治疗尿频、尿急、急迫性尿失禁、尿潴留和其他类型排尿功能障碍的常用方法。已经描述了将经皮永久性四极倒刺电极导线微创放置到骶孔中的方法。未报告电极导线移位。我们报告了我们的经验，与铅迁移和随后的失败的InterStim（R）在一个大的队列的patients.Materials和方法：2002年2月和2005年4月之间，235例患者使用InterStim（R）系统的S3孔内植入的电极导线电极的可能的诊断和抢救techniques。在测试阶段反应良好的患者（改善超过50%）接受植入式脉冲发生器的植入。通过术中影像学评价确认位置。骶骨X线片获得在术后第一次访问，IPG放置后，每当有一个变化，症状responsibility.Results：有5例（2.1%），其中治疗失败后，成功的试验刺激由于铅迁移。早在3周和晚至8个月时就出现了这种情况。在5例病例中，1例在第一阶段和第二阶段植入之间发生电极导线移位，4例在第二阶段之后发生。4例患者出现前移，1例患者出现后移。结论：置入双极电极导线后可能发生电极导线移位，因此应常规使用骶骨X线片。这种并发症可以很容易地解决，而不会对患者造成严重的发病率。
Purpose: Stimulation of the sacral nerves is a commonly used treatment for frequency, urgency, urge incontinence, retention and other types of voiding dysfunction. Minimally invasive placement of a percutaneous permanent quadripolar tined lead into the sacral foramen has been described. No lead migration has been reported. We report on our experience with lead migration and the subsequent failure of InterStim (R) in a large cohort of patients with a focus on possible diagnostic and salvage techniques.Materials and Methods: Between February 2002 and April 2005 tined lead electrodes were implanted in the S3 foramen in 235 patients using the InterStim (R) system. Patients with a good response during the testing phase (greater than 50% improvement) underwent placement of an implantable pulse generator. Position was confirmed by radiographic evaluation intraoperatively. Sacral radiographs were obtained at the first postoperative visit, after IPG placement and whenever there was a change in symptomatic response.Results: There were 5 patients (2.1%) in whom treatment failed after a successful trial of stimulation due to lead migration. This was seen as early as 3 weeks and as late as 8 months. Migration of the lead occurred between first and second stage implantation in 1 of the 5 cases, and occurred after the second stage in 4 of 5. Anterior migration was noted in 4 patients and posterior migration was noted in 1.Conclusions: Lead migration after placement of the tined lead can occur and thus sacral radiographs should be routinely used. This complication can be easily resolved without significant morbidity to the patient.