Deng Donna Y, Gulati Mittul, Rutman Matthew, Raz Shlomo, Rodríguez Larissa V
Department of Urology, University of California, San Francisco School of Medicine, San Francisco, USA.
J Urol. 2006 Jun;175(6):2182-5. doi: 10.1016/S0022-5347(06)00318-1.
Stimulation of the sacral nerves is a commonly used treatment for frequency, urgency, urge incontinence, retention and other types of voiding dysfunction. Minimally invasive placement of a percutaneous permanent quadripolar tined lead into the sacral foramen has been described. No lead migration has been reported. We report on our experience with lead migration and the subsequent failure of InterStim in a large cohort of patients with a focus on possible diagnostic and salvage techniques.
Between February 2002 and April 2005 tined lead electrodes were implanted in the S3 foramen in 235 patients using the InterStim system. Patients with a good response during the testing phase (greater than 50% improvement) underwent placement of an implantable pulse generator. Position was confirmed by radiographic evaluation intraoperatively. Sacral radiographs were obtained at the first postoperative visit, after IPG placement and whenever there was a change in symptomatic response.
There were 5 patients (2.1%) in whom treatment failed after a successful trial of stimulation due to lead migration. This was seen as early as 3 weeks and as late as 8 months. Migration of the lead occurred between first and second stage implantation in 1 of the 5 cases, and occurred after the second stage in 4 of 5. Anterior migration was noted in 4 patients and posterior migration was noted in 1.
Lead migration after placement of the tined lead can occur and thus sacral radiographs should be routinely used. This complication can be easily resolved without significant morbidity to the patient.
刺激骶神经是治疗尿频、尿急、急迫性尿失禁、尿潴留及其他类型排尿功能障碍的常用方法。经皮将永久性四极带倒刺电极微创置入骶孔的方法已见报道，尚未有电极移位的报告。我们报告了一大组患者中电极移位及后续InterStim治疗失败的经验，重点关注可能的诊断和挽救技术。
2002年2月至2005年4月，使用InterStim系统在235例患者的S3孔置入带倒刺电极。测试阶段反应良好（改善大于50%）的患者接受植入式脉冲发生器植入。术中通过影像学评估确认位置。术后首次就诊、植入IPG后及症状反应有变化时均拍摄骶骨X线片。
5例患者（2.1%）在成功的刺激试验后因电极移位导致治疗失败。最早在3周，最晚在8个月出现这种情况。5例中有1例电极移位发生在一期和二期植入之间，5例中有4例发生在二期植入后。4例患者出现向前移位，1例出现向后移位。
带倒刺电极置入后可能发生电极移位，因此应常规拍摄骶骨X线片。这种并发症可轻松解决，对患者无明显 morbidity。 （注：这里“morbidity”未准确翻译，因为在医学语境中它有多种含义，这里直接保留英文更合适，结合前文推测大致意思是对患者无明显不良影响之类的意思，但准确含义需结合更多背景知识）
