Abstract
Purpose
Neurostimulation of the pudendal nerve (PN) is considered for patients who have failed sacral neuromodulation. Previous techniques for PN localization are described to be uncomplicated and promise to achieve accuracy in electrode placement. However, in clinical use, they appear challenging. We developed a puncture technique using fixed anatomical landmarks for a fast and reproducible localization of the PN.
Methods
Full-body cadavers and dissected anatomical preparations were studied for the course of the PN. Fluoroscopically controlled fixed anatomical landmarks locating the pudendal trunk were defined. Lead placement following established techniques was performed, and the topographic relationship to the PN was documented by dissection. In a pilot series of 20 patients with chronic pelvic pain, pudendal neuromodulation (PNM) was performed uni- and bilateral using the different approaches. Technical and clinical outcomes of the various techniques were compared.
Results
Fixed anatomical landmarks such as ischial spine, ischial tuberosity, acetabulum and anal rim resulted in a right-angled triangle with a new start and target point for puncture. Initials of the landmarks add up to the teaching acronym STAR. STAR technique including a puncture angle of 60° and a gluteal lead exit places 3–4 electrode poles at the nerve. In clinical trial, mean operation time for bilateral PNM in STAR was 85 min with mean puncture attempts of 3.5 to reach the nerve. Pain decreased statistically significant only in bilateral PNM.
Conclusions
The STAR approach appears to achieve technical standardisation and optimized reproducibility in pudendal lead placement resulting into an increased feasibility of PNM.
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Acknowledgments
This study was awarded at the 22nd annual meeting of the Forum Urodynamicum 2011 in Mönchengladbach with the Eugen-Rehfisch-Prize.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standard
The study protocol was approved by the ethics committee of the Ruhr-University of Bochum on March 2011 (registration number: 3919-11) prior to the study. Written informed consent was obtained from all participants.
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Heinze, K., Hoermann, R., Fritsch, H. et al. Comparative pilot study of implantation techniques for pudendal neuromodulation: technical and clinical outcome in first 20 patients with chronic pelvic pain. World J Urol 33, 289–294 (2015). https://doi.org/10.1007/s00345-014-1304-7
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DOI: https://doi.org/10.1007/s00345-014-1304-7