1019 DOES BIOFILM RISK THE TREATMENT SUCCESS ATTAINED FROM THE TWO STEP IMPLANTATION OF A CHRONIC SACRAL NEUROMODULATOR?
2010-03-23

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20101019 DOES BIOFILM RISK THE TREATMENT SUCCESS ATTAINED FROM THE TWO STEP IMPLANTATION OF A CHRONIC SACRAL NEUROMODULATOR? Bastian Amend, Stephan Kruck, Jens Bedke, Arnulf Stenzl, and Karl-Dietrich Sievert Bastian AmendBastian Amend More articles by this author , Stephan KruckStephan Kruck More articles by this author , Jens BedkeJens Bedke More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , and Karl-Dietrich SievertKarl-Dietrich Sievert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2033AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chronic sacral neuromodulation (SNM) is a treatment option for idiopathic detrusor overactivity, chronic urinary retention due to detrusor underactivity, chronic pelvic pain and bowel dysfunction. As an alternative to peripheral nerve evaluation (PNE) that includes electrode dislocation risk and undervaluation of treatment responders, the two-step implantation offers the opportunity to evaluate treatment through the use of chronic electrodes over a prolonged screening period without the requirement to replace the initial electrode position. Less is known about the risk of infection during step I of the implantation with the skin-penetrating electrode extension and exact recommendations about the possible time period between electrode and neuromodulator implantation are still undocumented. Our study investigates implant infections during the two-step SNM. METHODS We evaluated eleven consecutive patients receiving two-step SNM for implant infections. 5 patients suffered from idiopathic detrusor overactivity with or without urinary incontinence, 4 from detrusor underactivity with chonic urinary retention and 2 from neurogenic stool incontinence due to clinical bowel overactivity. 6 patients received bilateral and 5 patients received unilateral electrodes positioned into the S3 foramen. During step II of the implantation, all extensions connected to the electrodes were sent for microbiological examination. RESULTS The time period between electrode and neuromodulator implantation was 49.6 days (29-116). Microbiological examinations resulted in the detection of biofilm-building bacteria in 5 patients (n=3 staphylococcus epidermidis, n=1 micrococcus and n=1 peptostreptococcus). The mean follow-up after neuromodulator implantation is currently 191 days (31-411). None of the patients demonstrated clinical signs of infection on the implantation side and percutaneous extension. Chronic neuromodulator implantation was performed in all patients without postoperative infection. No implant explantations were required. CONCLUSIONS Although biofilm-building bacteria was detected in approximately 45% of the patients, the SNM implantation was considered successful in relation to potential implant infections. Our study findings suggest that evaluation periods significantly longer than 14 days are possible without impacting the infection rate of the chronic implant, however, further investigations are necessary for a guideline recommendation. Tuebingen, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e396 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bastian Amend More articles by this author Stephan Kruck More articles by this author Jens Bedke More articles by this author Arnulf Stenzl More articles by this author Karl-Dietrich Sievert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...