A new tined lead, required for percutaneous implant, is now available. After insertion of the needle in the selected sacral foramen and after adequate testing for nerve responses, a metal stylet (directional guide) is inserted through the needle. The needle is removed and an incision is made for access. A dilator is inserted over the guide and advanced into the sacral foramen.
Leaving the introducer sheath in place, the tined lead is inserted and advanced under fluoroscopic control (Fig. 17.3). Once the responses of the various electrodes are confirmed, the introducer sheath is removed, thereby deploying the tines and anchoring the lead.5
Finally, a temporary and a permanent implant procedure can be combined. Once the permanent lead is implanted, a percutaneous extension is used to connect it to a temporary external stimulator allowing a long period of evaluation (1-2 months) of the effectiveness of sacral neuromodulation. If the response is confirmed, the percutaneous extension is replaced by an implantable extension connected to the IPG. Following the introduction of the minimally invasive technique, the two-stage modality has been recently proposed as an alternative to PNE.
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