Reduced radiation fluoroscopy technique for implantation of sacral neuromodulation

Introduction: Sacral neuromodulation (SNM) is a Food and Drug Administration-approved treatment option for urinary urgency and fecal incontinence. Fluoroscopic imaging is used at various steps during lead placement, which exposes the operating room staff and patient to the harmful effects of radiation. The aim of this study is to describe a reduced radiation technique during lead placement for treatment with SNM. Methods: A retrospective cohort of 51 consecutive patients who underwent lead insertion and SNM placement at a single academic institution were investigated. Reduced fluoroscopy (RF; n=11) involved C-arm settings to 1 pulse/second and an activated "low-dose" setting, while conventional fluoroscopy (CF; n=40) involved 30 pulses/second and a deactivated "low-dose" setting. The automatic brightness control and collimation were used optionally in both groups. Comparison of imaging quality, fluoroscopy settings, and radiation exposure during RF and CF was performed. Results: RF settings resulted in significant reduction of radiation compared to CF settings, including the fluoroscopy time (8.61 vs. 48.16 seconds; p<0.001), dose (2.66 vs. 26.25 mGy; p=0.001), and current (1.67 vs. 4.18 mAs; p<0.001). There was no significant difference in total operative time (59.18 vs. 61.33 minutes; p=0.77) and the rate of progression from stage 1 to stage 2 during follow-up (75% vs. 84%; p=0.55). Conclusions: Lead placement for treatment with SNM can be achieved using RF settings without compromising clinical outcomes. Applying the RF technique reduces overall radiation exposure to the patient and the operating room staff. Further validation of RF in a larger prospective cohort study is needed.