From the Guidelines
Sacral nerve stimulator placement surgery is generally considered a low surgical risk procedure. It is a minimally invasive surgery that typically involves two stages: a trial phase with temporary lead placement and, if successful, permanent implantation of the device 1. The procedure carries minimal risks compared to major abdominal or pelvic surgeries. Common complications are relatively minor and include pain at the implant site, lead migration, infection (occurring in up to 10% of patients) 1, and technical device issues.
Key Considerations
- The surgery is performed under local anesthesia with sedation or light general anesthesia, further reducing risks associated with deep anesthesia.
- Most patients can go home the same day or after a short hospital stay, with a recovery period of a few weeks before resuming normal activities.
- Individual risk factors such as age, overall health status, and comorbidities can influence the specific risk profile for each patient, so a thorough preoperative assessment is always necessary.
- The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) guideline amendment suggests that sacral neuromodulation (SNS) may be offered as a third-line treatment in carefully selected patients 1.
Outcome Prioritization
The primary consideration in recommending sacral nerve stimulator placement surgery is the potential impact on morbidity, mortality, and quality of life. Given the relatively low risk of complications and the potential for significant improvement in symptoms, this procedure can be considered a viable option for selected patients. However, it is essential to carefully evaluate each patient's individual risk factors and overall health status to determine the best course of treatment.
From the Research
Surgical Risk of Sacral Nerve Stimulator Placement
- The surgical risk of sacral nerve stimulator placement is relatively low, with few complications occurring on the day of surgery 2.
- However, device infection is a common complication, occurring in approximately 3-10% of cases 3, with an overall infection rate of 3.7% reported in a scoping review of 7446 patients 4.
- Infection can be serious and often requires complete explantation of the device 3, with most infection events treated with explantation 4.
- Other complications, such as bowel, urological, and neurological health events, are relatively low after sacral nerve stimulator placement 2.
- The risk of infection after tined lead pretest and neurostimulator placement may be higher than previously observed in older techniques 5.
- A new percutaneous technique of sacral nerve stimulation has been reported to have a high initial success rate and no complications 6.
Complication Rates
- A study of Medicare beneficiaries found that at 90 days, 3.2% of patients had bowel complications, 2.0% urological, 9.4% infectious, and 1.5% stroke 2.
- Another study found that 5 out of 37 (13.5%) women required device removal for culture positive wound infections after two-stage sacral nerve stimulator placement 5.
- A scoping review reported an overall infection rate of 3.7%, with 274 infection events reported out of 7446 patients 4.
Infection Prevention and Treatment
- Methods of infection prevention, such as antibiotic-impregnated collagen and type of skin preparation, have been studied 3.
- A protocol enacted at one institution resulted in an incidence of infection of 1.6% 3.
- There is currently no clear guidance on the treatment of infected sacral nerve stimulators, with most infection events treated with explantation 4.