title: Troubleshooting sacral neuromodulation issues.
abstract: In the past decade, the use of sacral neuromodulation has increased exponentially. The introduction of the tined lead, the posterior location, and the smaller IPG has changed the frequency and types of complications. These facts explain the reduction of the revision and explantation rates in the most contemporary series, as compared with the earlier data. Infection, pain at the IPG site, and reduced clinical response with or without impedance abnormalities are now the most frequently reported complications. Although infection should be managed with explantation of the entire system, device interrogation should be part of the physician's algorithm for managing patients with decreased sensation or new onset of pain, in order to check the integrity of the system. Patients who are not improved with new programs will most likely need surgical revision. The implanting physician should be aware of the ways to evaluate and manage complications and suboptimal responses, to appropriately troubleshoot patients, and to reduce the need for surgical revision.
authors.affiliation: Female Pelvic Medicine & Reconstructive Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. carmelm@ccf.org
authors.forename: Maude E
authors.initials: ME
authors.lastname: Carmel
authors.forename: Sandip P
authors.initials: SP
authors.lastname: Vasavada
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D004567:Electrodes, Implanted / Q000009:adverse effects; D006801:Humans; D007239:Infections / Q000188:drug therapy / Q000209:etiology; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis* / Q000628:therapy*; D008160:Lumbosacral Plexus; D019919:Prosthesis Implantation / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents