From the Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH.
Female Pelvic Med Reconstr Surg. 2020 Mar;26(3):e13-e15. doi: 10.1097/SPV.0000000000000818.
This study aimed to present 2 cases with unusual lead complications in InterStim devices implanted in patients with refractory overactive bladder symptoms.
Two patients with InterStim implants presented with loss of efficacy. Both patients required lead revision surgery with findings of a twisted lead with associated lead migration.
In both cases, revision surgery revealed twisting of the InterStim lead causing retrograde lead displacement. Patients were managed with lead removal and placement of a new lead. At the time of revision, one patient had a seroma within a large pocket of the implantable pulse generator (IPG) site, which was managed with closure and development of a new IPG pocket. In both cases, revision with new lead placement resulted in significant symptom improvement.
Sacral neuromodulation lead complications are known to be among the most consequential adverse events. We report the first 2 cases, to our knowledge, of patients presenting with an InterStim device that lost efficacy due to lead twisting and subsequent retrograde lead migration, likely due to rotation of the IPG within the gluteal pocket. This finding is easily remedied with IPG pocket revision and lead replacement.
本研究旨在介绍 2 例因难治性膀胱过度活动症而植入 InterStim 装置的患者出现异常导联并发症。
2 例植入 InterStim 装置的患者出现疗效丧失。这 2 名患者均需进行导联修正手术，术中发现导联扭曲并伴有导联迁移。
在这 2 例病例中，修正手术均显示 InterStim 导联扭曲导致逆行导联移位。患者接受了导联移除和新导联植入的治疗。在修正手术时，1 例患者的可植入脉冲发生器（IPG）部位有一个大的囊腔中有血清肿，采用缝合和新 IPG 囊腔形成进行处理。在这 2 例病例中，修正并植入新的导联后，症状均显著改善。
骶神经调节导联并发症是最严重的不良事件之一。我们报告了首例 2 例患者的病例，他们的 InterStim 装置因导联扭曲和随后的逆行导联迁移而失去疗效，可能是由于 IPG 在臀袋内旋转所致。这种情况可以通过修正 IPG 囊腔和更换导联很容易地解决。
