Karapanos Leonidas, Chon Seung-Hun, Kokx Ruud, Schmautz Maximilian, Heidenreich Axel
Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Surgery, University of Cologne, Faculty of medicine, University Hospital Cologne, Cologne, Germany.
Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Faculty of medicine, University Hospital Cologne, Cologne, Germany.
Turk J Urol. 2020 Nov;46(6):492-495. doi: 10.5152/tud.2020.20320. Epub 2020 Oct 1.
After the introduction of self-anchoring tined leads in 2002, lead migration after sacral neuromodulation (SNM) in the form of InterStim (Medtronic, Minneapolis, MN) has been reduced; however, it remains a considerable complication of this otherwise low-risk procedure. As intestinal perforation through lead migration or primary incorrect positioning portrays a rarity and has been scarcely reported in the literature, no algorithm for explantation in such cases has been determined. We present a case of a young man with an SNM device implant (InterStim II) because of neurogenic urinary retention, who was admitted with inflammation, localized at the sacral lead insertion site. Our diagnostic algorithm revealed a tined lead electrode protruding into the rectum without concomitant abscess. We performed an interdisciplinary surgical approach combining regular incisions over the sacrum and buttocks for dissection of the lead and the implanted pulse generator, respectively, with an endoscopic transanal lead extraction. This method prevented further bacterial seeding in the surrounding tissues of the colon and, therefore, presacral abscess formation or sacral osteomyelitis. Combined surgical-endoscopic removal of the InterStim device is an effective and safe procedure that should be included in the armamentarium of urologists performing neuromodulation surgery in cases of intestinal perforation.
2002年自锚定叉状电极导线引入后，骶神经调节（SNM）（以美敦力公司位于明尼阿波利斯的InterStim为例）术后导线移位情况有所减少；然而，在这种原本低风险的手术中，导线移位仍是一个相当严重的并发症。由于导线移位或初始定位错误导致肠道穿孔极为罕见，且文献中鲜有报道，因此尚未确定此类病例的取出算法。我们报告一例因神经源性尿潴留植入SNM装置（InterStim II）的年轻男性，因骶部导线插入部位出现炎症而入院。我们的诊断算法显示叉状电极导线突入直肠但未伴有脓肿。我们采用了一种多学科手术方法，分别在骶骨和臀部做常规切口，用于分离导线和植入的脉冲发生器，同时经肛门内镜取出导线。这种方法避免了细菌在结肠周围组织进一步播散，从而预防了骶前脓肿形成或骶骨骨髓炎。联合手术 - 内镜取出InterStim装置是一种有效且安全的手术方法，在肠道穿孔的情况下，应纳入进行神经调节手术的泌尿外科医生的手术手段中。
