• Ada Rosen, Sorin Elias, Hadas Ganer Herman, Alexander Condrea, and Shimon Ginath.
• Department of Surgery A and Proctology, Wolfson Medical Center, Holon, Israel.
• Isr Med Assoc J. 2021 Dec 1; 23 (12): 773-776.

BackgroundThe current approach to performing sacral neuromodulation consists of a two-stage procedure, the first of which includes insertion of the sacral electrode under fluoroscopic visualization of the S3 foramen. Alternatively, in certain situations computed tomography (CT)-guided insertion can be used.ObjectivesTo evaluate the use of CT in cases of reinsertion of the electrode due to infection, dislocation, or rupture.MethodsMedical records of patients who underwent neuromodulation device reinsertion between 2005 and 2016 for fecal incontinence were reviewed. Study outcomes included procedure course, successful placement, and long-term treatment success.ResultsDuring the study period, we inserted a neuromodulation device in 67 patients. A CT-guided insertion of a sacral electrode was performed in 10 patients. In nine patients, the insertion and the final location of the electrode were successful. In one patient, the electrode migrated upward due to a malformation of the S3 foramen on both sides and had to be placed in S4. In a mean follow-up of 68.4 ± 30.0 months following the re-insertion, there was a significant reduction in the number of incontinence episodes per day (P < 0.001) and the number of pads used per day (P = 0.002).ConclusionsCT-guided insertion of a sacral electrode is a safe and promising option, especially in recurrent and or selected cases.

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