V02-12 TWIDDLER SYNDROME IN SACRAL NEUROMODULATION: A SURGICAL APPROACH

You have accessJournal of UrologyFemale Voiding Dysfunction/ Pelvic Floor Disorders/ Incontinence/ Neuro-Urology (V02)1 May 2024V02-12 TWIDDLER SYNDROME IN SACRAL NEUROMODULATION: A SURGICAL APPROACH Andrea J. Moyer, Alexandra Tabakin, and Wai Lee Andrea J. MoyerAndrea J. Moyer , Alexandra TabakinAlexandra Tabakin , and Wai LeeWai Lee View All Author Informationhttps://doi.org/10.1097/01.JU.0001008636.33664.3e.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sacral neuromodulation (SNM) is a third line treatment modality for urinary frequency, urgency incontinence, and non-obstructive urinary retention. Twiddler syndrome is a rare condition in which the neurostimulator implant is inadvertently manipulated within its subcutaneous pocket. This has been most commonly described in cardiac pacemakers. The twisting of the leads can lead to irreparable damage, requiring lead revision. Koch et al. described a method to place the pulse generator in a sutured absorbable antimicrobial pouch, but this can be potentially costly and not always readily available. Objective: We present our experience with 3 patients with Twiddler syndrome after sacral neuromodulation with the non-rechargeable battery and our technique for repair. METHODS: Clinical Cases: We describe 3 unique cases of women aged 69, 55, and 31 years old all presenting less than 3 months after SNM device placement with discomfort at the battery site. All patients had freely mobile batteries palpable on time of exam. Body mass index (BMI) ranged from 29.1 kG/m2 to 45.1 kG/m2. X-rays were obtained for each patient, and they demonstrated twisting of the leads (Figure 1A-C). RESULTS: They subsequently were taken to the operating room for battery revision. One patient's lead had severed completely from the overtwisting and the lead had to be revised. The leads were able to be unraveled for the other 2 patients. To prevent Twiddler syndrome from recurring, a 2-0 Polypropylene suture was secured around the battery groove near the lead insertion site and sutured to the deep lateral edge of the subcutaneous pocket. Post-operative x-rays demonstrated the device to be in a stable position at a maximal follow-up interval of 5 months (Figure 1D-E). CONCLUSIONS: Clinical Discussion: We described a cost-effective surgical approach for Twiddler syndrome. Our technique has demonstrated durability for up to 5 months post-operatively but further long-term follow-up and imaging is needed. All of our patients were diagnosed early with physical exam and x-ray pre-operatively and resulted in salvage of 2 of 3 leads. Future consideration includes placing a prophylactic stay suture at the time of implantation to patients deemed at risk preoperatively or at the time of surgery during subcutaneous pocket creation. Download PPT Source of Funding: none © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e103 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Andrea J. Moyer More articles by this author Alexandra Tabakin More articles by this author Wai Lee More articles by this author Expand All Advertisement PDF downloadLoading ...