Turkish Journal of Urology
NEUROUROLOGY - Case Report

A rare case of tined lead migration of InterStim device into the rectum with subsequent novel combined surgical-endoscopic removal technique

1.

Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Surgery, University of Cologne, Faculty of medicine, University Hospital Cologne, Cologne, Germany

2.

Department of General, Visceral, Cancer and Transplant Surgery, University of Cologne, Faculty of medicine, University Hospital Cologne, Cologne, Germany

Turk J Urol 2020; 46: 492-495
DOI: 10.5152/tud.2020.20320
Read: 98 Downloads: 28 Published: 01 October 2020

After the introduction of self-anchoring tined leads in 2002, lead migration after sacral neuromodulation (SNM) in the form of InterStimTM (Medtronic, Minneapolis, MN) has been reduced; however, it remains a considerable complication of this otherwise low-risk procedure. As intestinal perforation through lead migration or primary incorrect positioning portrays a rarity and has been scarcely reported in the literature, no algorithm for explantation in such cases has been determined. We present a case of a young man with an SNM device implant (InterStim II®) because of neurogenic urinary retention, who was admitted with inflammation, localized at the sacral lead insertion site. Our diagnostic algorithm revealed a tined lead electrode protruding into the rectum without concomitant abscess. We performed an interdisciplinary surgical approach combining regular incisions over the sacrum and buttocks for dissection of the lead and the implanted pulse generator, respectively, with an endoscopic transanal lead extraction. This method prevented further bacterial seeding in the surrounding tissues of the colon and, therefore, presacral abscess formation or sacral osteomyelitis. Combined surgical-endoscopic removal of the InterStim device is an effective and safe procedure that should be included in the armamentarium of urologists performing neuromodulation surgery in cases of intestinal perforation.

Cite this article as: Karapanos L, Chon SH, Kokx R, Schmautz M, Heidenreich A. A rare case of tined lead migration of InterStim device into the rectum with subsequent novel combined surgical-endoscopic removal technique. Turk J Urol 2020; 46(6): 492-5.

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ISSN 2149-3235 EISSN 2149-3057