V10-04: Sacral Neuromodulation Lead Removal; A Novel Technique.
Approximately 50,000 sacral neuromodulation implants have occurred for the treatment of lower urinary tract symptoms. Explantation occurs at a rate of 6-24.6% within an average of 18-44 months after placement. Removal of tined leads may be secondary to infection, pain, lead migration, lack of efficacy or device malfunction. Tension placed on the lead during extraction may cause fracture of the lead resulting in retained fragments. The amount of morbidity and mortality of retained fragments or more invasive removal procedures is unknown. Potential health complications of retained leads include pain, infection, lead-fragment migration, MRI complications, and viscous perforation. Cardiologists often use a locking stylet to aide in the removal of pacemaker leads where intact removal is absolutely necessary. A lead extracting device deploys a braided mesh that expands to secure the lead’s hollow lumen allowing the physician to apply a steady traction on the lead, allowing complete removal. Objective: To offer a novel, safe, and effective technique for the complete removal of sacral neuromodulation leads
The procedure for sacral lead removal begins with a 1cm incision made above the site of the identified lead. Using a right angle clamp the lead is identified and brought through the incision. The lead is then cut and detached from its attachment to the pulse generator. The lead extracting device is threaded through the lead to the distal tip, this is performed under fluoroscopy and the radio-opaque tip of the device is followed upon placement. The lead extracting device is deployed, and a braided mesh expands through the hollow lumen of the lead. With gentle traction the sacral lead is removed completely intact.
Complete removal of sacral neuromodulation lead using a lead extracting device.
Use of a lead extracting device may help to prevent fragmentation of the lead, decreasing the need for a more invasive approach. Adequate data on lead fracture and associated morbidity is limited. This is a place where the opportunity for potential research exists.