Sacral Neuromodulation in Children With Dysfunctional Elimination Syndrome: Description of Incisionless First Stage and Second Stage Without Fluoroscopy
Received 10 September 2008; accepted 27 October 2008. published online 23 January 2009.
Objectives
To detail a percutaneous technique of sacral nerve neuromodulation (SN) that eliminates the first-stage incisions and the need for second-stage fluoroscopy. Our group has previously described the results of SN in children with medically refractory dysfunctional elimination syndrome. The drawbacks to SN include the use of fluoroscopy and the need to reopen recent skin incisions during the second stage. This results in increased radiation exposure, poor cosmesis, and possible wound infection.
Methods
The incisionless first stage consisted of percutaneously tunneling the temporary external appliance to the contralateral axillary line at the buttock after localization of the S3 nerve root and placement of a quadripolar tined lead under fluoroscopic guidance. A subcutaneous bolus of methylene blue marked the lead connector site, obviating the need for later fluoroscopic localization to place the implantable pulse generator at the second stage.
Results
A total of 27 children with refractory dysfunctional elimination syndrome underwent SN using the InterStim device. Of the 27 patients, 19 underwent our modified technique. The operative time for our modified tunneling and placement technique was ≤2 minutes. The mean hospital stay was 0.6 day, with no patient requiring postoperative intravenous narcotics. At a mean follow-up of 35.9 months, no wound infections had occurred in the incisionless cohort compared with 1 postoperative wound infection requiring device explantation in the conventional lead placement group.
Conclusions
The incisionless technique of SN device implantation is technically simple, quick to perform, and results in decreased radiation exposure, excellent pain control, and improved cosmesis without compromising the outcomes.
aDepartment of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota
bDivision of Urology, Children's Hospital of Minnesota, Minneapolis, Minnesota
Reprint requests: Shawn M. McGee, M.D., Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester MN 55905
ABSTRACT