Modified techniques of S3 foramen localization and lead implantation in S3neuromodulation

Introduction. We describe a reproducible and less invasive surgical approac h to sacral neuromodulation (InterStim Therapy) in the treatment of voiding dysfunction. Twenty patients underwent modified lead implantation (mean op erative time 45 minutes) without any difficulties or complications, with a mean follow-up of 8 months (range 1 to 14). Technical Considerations. The highlights of these modifications include (a) fluoroscopy to localize the S3 foramen; (b) paramedian incision; (c) use o f a cutoff S3 finder needle and a 14-gauge Angiocath to direct permanent le ad into the S3 foramen without dissection; (d) use of lateral fluoroscopy t o determine the depth of the Angiocath insertion; and (e) anchoring the lea d to the lumbodorsal fascia (superficial to the sacral periosteum) using a moveable lead anchor system. These modifications simplify and minimize the invasiveness of this therapy without compromising the efficacy. Conclusions. Because of the simplicity of these modifications, we are curre ntly using an implanted lead, rather than the temporary percutaneous lead, to assess patients' clinical response before implanting a pulse generator. (C) 2001, Elsevier Science Inc.