scholarly journals Removal of sacral neuromodulation quadripolar tined-lead using a straight stylet: description of a surgical technique

2021 ◽  
Author(s):  
M. Agnello ◽  
M. Vottero ◽  
P. Bertapelle
Keyword(s):  
Adverse Effects ◽  
Sacral Neuromodulation ◽  
Pulse Generator ◽  
Lead Removal ◽  
Open Technique ◽  
Implantable Pulse Generator ◽  
Beneficial Effects ◽  
Tined Lead ◽  
Removal Technique ◽  
Sacral Bone

Abstract Background Up to 7.5% of tined-lead removals in patients having sacral neuromodulation (SNM) therapy are associated with a lead breakage. It is still unclear what adverse effects can be caused by unretrieved fragments. The aim of our study was to describe the lead removal technique we have been using for the last 2 years in our centre. Methods We retrospectively enrolled patients who had lead removal between January 2018 and January 2020 using our standardized technique. The novelty of the technique is in the use of the straight stylet, which is available in the quadripolar tined-lead kit. The stylet gives the electrode greater stiffness, reducing interactions with surrounding tissues and probability of damage or breakage during removal. Results In 59 patients (42 women, mean age 57.2 years [range 40–79 years]) the lead was removed using our standardized technique. In 44 of 59 patients, the tined-lead was removed within 2 months from the SNM-test, due to lack of beneficial effects. In 15 patients the electrode was removed because of failure of definitive implantation. Meantime from definitive implantable pulse generator (IPG) implantation to lead removal was 67.9 months. We recorded only 1 case of lead-breakage during removal: a female patient with a non-tined lead fixed on sacral bone, placed 18 years previously using an open technique. Conclusions Lead breakage during removal is not uncommon and adverse effects of retained fragments may occur. Our technique has been safely used for the last 2 years in our centre, with no episodes of lead breakage or retained fragments, except for one non-tined electrode.

Buttock Placement of the Implantable Pulse Generator: A New Implantation Technique for Sacral Neuromodulation – A Multicenter Study

2001 ◽  
Vol 40 (4) ◽  
pp. 434-438 ◽  
Author(s):  
W.A. Scheepens ◽  
E.H.J. Weil ◽  
G.A. van Koeveringe ◽  
D. Rohrmann ◽  
H.E.M. Hedlund ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Sacral Neuromodulation ◽  
Pulse Generator ◽  
Implantation Technique ◽  
Implantable Pulse Generator

scholarly journals Current Position of Sacral Neuromodulation in Treatment of Fecal Incontinence

2021 ◽  
Vol 34 (01) ◽  
pp. 022-027
Author(s):  
Binit Katuwal ◽  
Jasneet Bhullar
Keyword(s):  
Fecal Incontinence ◽  
Pulse Generator ◽  
Lumbar Region ◽  
Current Position ◽  
Beneficial Effects ◽  
Tined Lead ◽  
Neurologic Function ◽  
Complex Relationships ◽  
Limited Physical Activity ◽  
Lower Lumbar

AbstractFecal incontinence (FI) is defined as uncontrolled passage of feces or gas for at least 1-month duration in an individual who previously had control. FI is a common and debilitating condition affecting many individuals. Continence depends on complex relationships between anal sphincters, rectal curvatures, rectoanal sensation, rectal compliance, stool consistency, and neurologic function. Factors, such as pregnancy, chronic diarrhea, diabetes mellitus, previous anorectal surgery, urinary incontinence, smoking, obesity, limited physical activity, white race, and neurologic disease, are known to be the risk factors for FI. Conservative/medical management including biofeedback are recognized as the first-line treatment of the FI. Those who are suitable for surgical intervention and who have failed conservative management, sacral nerve stimulation (SNS) has emerged as the treatment of choice in many patients. The surgical technique involves placement of a tined lead with four electrodes through the S3 sacral foramen. The lead is attached to a battery, which acts as a pulse generator, and is placed under the patient's skin in the lower lumbar region. The use of SNS in the treatment of FI has increased over the years and the beneficial effects of this treatment have been substantiated by multiple studies. This review describes SNS as a modality of treatment for FI and its position in the current medical diaspora in patients with FI.

scholarly journals Predictors of Implantable Pulse Generator Placement After Sacral Neuromodulation: Who Does Better?

2013 ◽  
Vol 17 (4) ◽  
pp. 381-384 ◽  
Author(s):  
Jennifer T. Anger ◽  
Anne P. Cameron ◽  
Rodger Madison ◽  
Christopher Saigal ◽  
J. Quentin Clemens ◽  
...  
Keyword(s):  
Sacral Neuromodulation ◽  
Pulse Generator ◽  
Implantable Pulse Generator

Sacral Neuromodulation with an Implantable Pulse Generator in Children with Lower Urinary Tract Symptoms: 15-Year Experience

2012 ◽  
Vol 188 (4) ◽  
pp. 1313-1318 ◽  
Author(s):  
Luitzen-Albert Groen ◽  
Piet Hoebeke ◽  
Nele Loret ◽  
Charles Van Praet ◽  
Erik Van Laecke ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
Sacral Neuromodulation ◽  
Pulse Generator ◽  
Implantable Pulse Generator ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement

2020 ◽  
Vol 133 (2) ◽  
pp. 403-410 ◽  
Author(s):  
Travis J. Atchley ◽  
Nicholas M. B. Laskay ◽  
Brandon A. Sherrod ◽  
A. K. M. Fazlur Rahman ◽  
Harrison C. Walker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Pulse Generator ◽  
Rank Test ◽  
Implantable Pulse Generator ◽  
Device Infection ◽  
Deep Brain

OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

scholarly journals Effect of defibrillation on the performance of an implantable vagus nerve stimulation system

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Imad Libbus ◽  
Scott R. Stubbs ◽  
Scott T. Mazar ◽  
Scott Mindrebo ◽  
Bruce H. KenKnight ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Function ◽  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Pulse Generator ◽  
High Energy ◽  
Implantable Pulse Generator ◽  
Defibrillation Pulse ◽  
Stimulation System

Abstract Background Vagus Nerve Stimulation (VNS) delivers Autonomic Regulation Therapy (ART) for heart failure (HF), and has been associated with improvement in cardiac function and heart failure symptoms. VNS is delivered using an implantable pulse generator (IPG) and lead with electrodes placed around the cervical vagus nerve. Because HF patients may receive concomitant cardiac defibrillation therapy, testing was conducted to determine the effect of defibrillation (DF) on the VNS system. Methods DF testing was conducted on three ART IPGs (LivaNova USA, Inc.) according to international standard ISO14708-1, which evaluated whether DF had any permanent effects on the system. Each IPG was connected to a defibrillation pulse generator and subjected to a series of high-energy pulses. Results The specified series of pulses were successfully delivered to each of the three devices. All three IPGs passed factory electrical tests, and interrogation confirmed that software and data were unchanged from the pre-programmed values. No shifts in parameters or failures were observed. Conclusions Implantable VNS systems were tested for immunity to defibrillation, and were found to be unaffected by a series of high-energy defibrillation pulses. These results suggest that this VNS system can be used safely and continue to function after patients have been defibrillated.

scholarly journals PD36-03 12 YEAR SINGLE CENTER RETROSPECTIVE REVIEW OF RISK FACTORS AND RATE OF TINED LEAD BREAKAGE DURING SACRAL NEUROMODULATION LEAD EXPLANT

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Jessica Rueb* ◽  
Javier Pizarro-Berdichevsky ◽  
Samir Derisavifard ◽  
Laura Giusto ◽  
Patricia Zahner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Review ◽  
Sacral Neuromodulation ◽  
Single Center ◽  
Tined Lead
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