Removal of Sacral Neuromodulation Devices Is an Office Procedure.

OBJECTIVE

To present our experience removing sacral neuromodulation (SNM) components under local in the office. In some instances, SNM devices need to be removed. Traditionally, permanent lead and/or implantable pulse generator (IPG) removals are done in the operating room under sedation. However, it is our practice to perform this procedure in the office using only local anesthesia.

MATERIALS AND

METHODS

We performed a retrospective chart review from 2017 to 2022 of SNM lead and IPG removals performed under local anesthesia in the office by a single surgeon. Patient characteristics, outcomes, and complications were reported.

RESULTS

From 2017 to 2022, 41 SNM leads with and without IPGs were removed in the office using local anesthesia. 88% were female, mean age 66 ± 15.8years, and mean body mass index 28.6 (19.1-49.4). The most common indications for SNM treatment were urgency incontinence (56%) and nonobstructive urinary retention (24%). 44% (18/41) of SNM device removals were leads removed after failed stage I and 56% (23/41) were leads with IPGs removed most commonly for decreased efficacy (52%). In the latter group, median time to removal was 3.1 (0.3-12.3) years, and 52% (12/23) required a separate medial incision for lead retrieval. 9% (2/23) required fluoroscopy, of which, one was planned secondary to body mass index 49.4, and the other needed secondary to excessive scar tissue. No stage I failures required fluoroscopy. 7% (3/41) of leads required cutdown to the sacrum for removal with leads in place between 3.1 and 3.9years. All leads were removed completely intact and there were no complications.

CONCLUSION

Removal of SNM devices in the office using local anesthesia is effective, well-tolerated, and safe.