Abstract
Background
Sacral neuromodulation (SNM) is an advanced therapy that stimulates sacral spinal
nerves to modulate bladder or bowel dysfunction and is approved for the treatment
of overactive bladder, fecal incontinence, and non-obstructive urinary retention.
Prior to implantation, a successful trial period must be performed via percutaneous
nerve evaluation (PNE) or a staged trial to assess treatment efficacy. Ideal lead
placement in the S3 foramen is imperative to produce an adequate response and successful
outcome. Traditional lead placement with fluoroscopic guidance utilizes the anteroposterior
(AP) and lateral views. In this abstract we describe an additional modification which
may aid lead placement.
Objective
This video demonstrates the bullseye technique to obtain S3 foramen access for optimal
lead placement in SNM.
Methods/Material
Begin the procedure by placing the patient in the prone position. The medial edges
of the S3 foramen are marked bilaterally in the AP view followed by a horizontal marking
at the level of S3. The pelvis is imaged with live fluoroscopy starting at 0 degrees
and then rotating the C-arm to 30 degrees. This rotation allows the “opening up” of
the S3 foramen from an ellipsoid to an oval. The surgeon grasps the needle with a
Kelly clamp, placing it at the level of the skin approximately 2 cm cephalad from
the horizontal marking. Live fluoroscopy is performed to align the needle with the
image intensifier to form the bullseye. Once the correct angle is identified, the
needle is advanced. The procedure is repeated on the contralateral foramen.
Results
The bullseye technique allows quick and predictable access into S3. It can potentially
decrease operating time, minimize needle entries in PNE, and allows the surgeon to
access S3 while maintaining proper medial orientation.
Conclusion
The bullseye technique can assist surgeons in obtaining optimal access in SNM and
can quickly be integrated into current practices.
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References
- International Continence society best practice statement for use of sacral neuromodulation.Neurourol Urodyn. 2018; 37 (Epub 2018 Apr 11. PMID: 29641846): 1823-1848https://doi.org/10.1002/nau.23515
- Sacral neuromodulation: determining predictors of success.Urology. 2021; 153 (Epub 2020 Jun 30. PMID: 32619594): 124-128https://doi.org/10.1016/j.urology.2020.06.023
- Sacral neuromodulation: troubleshooting needle placement.Int Urogynecol J. 2021; 32 (Epub 2021 Jan 8. PMID: 33416966): 2549-2551https://doi.org/10.1007/s00192-020-04614-9
- Sacral neuromodulation: sacral anatomy and optimal lead placement.Int Urogynecol J. 2021; 32 (Epub 2020 Nov 25. PMID: 33237358): 2545-2547https://doi.org/10.1007/s00192-020-04615-8
- Long-term outcome and surgical interventions after sacral neuromodulation implant for lower urinary tract symptoms: 14-year experience at 1 center.J Urol. 2011; 185 (Epub 2011 Jan 19. PMID: 21247597): 981-986https://doi.org/10.1016/j.juro.2010.10.054
Article info
Publication history
Published online: November 02, 2022
Accepted:
October 17,
2022
Received:
August 31,
2022
Footnotes
Financial disclosure: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
