Skip to main content

Advertisement

SpringerLink
Log in

Sacral Neuromodulation Implant Infection: Risk Factors and Prevention

  • Lower Urinary Tract Symptoms & Voiding Dysfunction (J Sandhu, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Device infection is one of the most common complications of sacral nerve stimulator placement and occurs in approximately 3–10% of cases. Infection is a serious complication, as it often requires complete explantation of the device. Not much is known regarding risk factors for and methods of preventing infection in sacral nerve stimulation. Multiple risk factors have been linked to device infection including prolonged percutaneous testing and choice of preoperative antibiotic. Methods of infection prevention have also been studied recently, including antibiotic-impregnated collage and type of skin preparation. This review will discuss the recent literature identifying risk factors and means of preventing infection in sacral nerve stimulation. Finally, we will outline a protocol we have enacted at our institution which has resulted in an incidence of infection of 1.6%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Carmel ME, Vasavada SP, Goldman HB. Troubleshooting sacral neuromodulation issues. Curr Urol Rep. 2012;13(5):363–9.

    Article  PubMed  Google Scholar 

  2. White WM, Mobley JD, Doggweiler R, Dobmeyer-Dittrich C, Klein FA. Incidence and predictors of complications with sacral neuromodulation. Urology. 2009;73(4):731–5.

    Article  PubMed  Google Scholar 

  3. Wexner SD, Hull T, Edden Y, Coller JA, Devroede G, McCallum R, et al. Infection rates in a large investigational trial of sacral nerve stimulation for fecal incontinence. J Gastrointest Surg. 2010;14(7):1081–9.

    Article  PubMed  Google Scholar 

  4. Mellgren A, Wexner SD, Coller JA, Devroede G, Lerew DR, Madoff RD, et al. Long-term efficacy and safety of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum. 2011;54(9):1065–75.

    Article  PubMed  Google Scholar 

  5. Guralnick ML, Benouni S, O’Connor RC, Edmiston C. Characteristics of infections in patients undergoing staged implantation for sacral nerve stimulation. Urology. 2007;69(6):1073–6.

    Article  PubMed  Google Scholar 

  6. Huwyler M, Kiss G, Burkhard FC, Madersbacher H, Kessler TM. Microbiological tined-lead examination: does prolonged sacral neuromodulation testing induce infection? BJU Int. 2009;104(5):646–50. discussion 650.

    Article  PubMed  Google Scholar 

  7. Dudding T, Vaizey C. Bacterial colonization of stimulation electrode wires in patients undergoing temporary sacral nerve stimulation. Colorectal Dis. 2010;12(2):141–3.

    Article  CAS  PubMed  Google Scholar 

  8. Kessler TM, Burkhard FC, Madersbacher H, Kofler A, Poewe W, Kiss G. Safety of prolonged sacral neuromodulation tined lead testing. Curr Med Res Opin. 2008;24(2):343–7.

    Article  PubMed  Google Scholar 

  9. •• Lai HH, Grewal S. Bacterial colonization rate of InterStim and infection outcome with staged testing. Urology. 2013;82(6):1255–60. This is a prospective study following 38 patients who underwent sacral neuromodulation. This study gives evidence linking prolonged stage 1 testing with bacterial colonization and subsequent device infection.

    Article  PubMed  Google Scholar 

  10. Wolf JS, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008;179(4):1379–90.

    Article  PubMed  Google Scholar 

  11. •• Amend B, Bedke J, Khalil M, Stenzl A, Sievert K-D. Prolonged percutaneous SNM testing does not cause infection-related explanation. BJU Int. 2013;111(3):485–91. This is a prospective study that followed 21 patients who received sacral nerve stimulation for a variety of indications. This study is notable because, after a mean stage 1 testing period of 52 days, none of the patients developed subsequent device infection.

    Article  PubMed  Google Scholar 

  12. •• Haraway AM, Clemens JQ, He C, Stroup C, Atiemo HO, Cameron AP. Differences in sacral neuromodulation device infection rates based on preoperative antibiotic selection. Int Urogynecol J. 2013;24(12):2081–5. This is a retrospective study looking at outcomes in 136 patients who underwent sacral nerve stimulator placement. Infection rates were compared according to type of preoperative antibiotic that was used. The study demonstrated that choice of preoperative antibiotic could affect the risk of subsequent infection.

    Article  PubMed  Google Scholar 

  13. •• Clifton M, Quirouet A, Pizarro-Berdichevsky J, Gill B, Dielubanza E, Okafor H, et al. Infection rate after sacral neuromodulation surgery: a review of 1033 InterStim procedures. Neurourol Urodynam. 35(S1):S57. This was a retrospective study that included all 1033 sacral nerve stimulator procedures performed at the Cleveland Clinic between 2010 and 2015. This study is notable for the low rate of infection (1.6%) achieved in part by using the infection prevention protocol outlined in this review. This study also identifies pre-implant indication of non-obstructive urinary retention as a significant risk factor for subsequent infection.

  14. Simpson JAD, Peacock J, Maxwell-Armstrong C. Use of a gentamicin-impregnated collagen sheet (Collatamp(®)) following implantation of a sacral nerve stimulator for faecal incontinence. Colorectal Dis. 2012;14(4):e200–2.

    Article  CAS  PubMed  Google Scholar 

  15. Andersson RE, Lukas G, Skullman S, Hugander A. Local administration of antibiotics by gentamicin-collagen sponge does not improve wound healing or reduce recurrence rate after pilonidal excision with primary suture: a prospective randomized controlled trial. World J Surg. 2010;34(12):3042–8.

    Article  PubMed  Google Scholar 

  16. Bennett-Guerrero E, Pappas TN, Koltun WA, Fleshman JW, Lin M, Garg J, et al. Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med. 2010;363(11):1038–49.

    Article  CAS  PubMed  Google Scholar 

  17. •• Tuuli MG, Liu J, Stout MJ, Martin S, Cahill AG, Odibo AO, et al. A randomized trial comparing skin antiseptic agents at Cesarean delivery. N Engl J Med. 2016;374(7):647–55. This was a randomized controlled trial that enrolled 1147 patients to receive either chlorhexidine-alcohol or iodine-alcohol as skin preparation prior to Cesarean section. This study identified different incidences of infection with different skin preparations, suggesting that certain skin preparations may be more effective than others for preventing surgical site infection.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. • Kapadia BH, Zhou PL, Jauregui JJ, Mont MA. Does preadmission cutaneous chlorhexidine preparation reduce surgical site infections after total knee arthroplasty? Clin Orthop Relat Res. 2016. This was a prospective cohort study in which 3717 patients were given chlorhexidine cloths to cleanse the surgical site prior to total knee arthroplasty. This study demonstrates that having patients begin infection prevention at home prior to their procedure may further reduce the incidence of surgical site infection.

  19. Kapadia BH, Jauregui JJ, Murray DP, Mont MA. Does preadmission cutaneous chlorhexidine preparation reduce surgical site infections after total hip arthroplasty? Clin Orthop Relat Res. 2016.

  20. Morrison TN, Chen AF, Taneja M, Küçükdurmaz F, Rothman RH, Parvizi J. Single vs repeat surgical skin preparations for reducing surgical site infection after total joint arthroplasty: a prospective, randomized, double-blinded study. J Arthroplasty. 2015.

  21. •• Chen H-C, Chen M-C, Chen Y-L, Tsai T-H, Pan K-L, Lin Y-S. Bundled preparation of skin antisepsis decreases the risk of cardiac implantable electronic device-related infection. Europace. 2015. This is a prospective cohort study in which 665 patients undergoing placement of implantable cardiac devices were enrolled to receive either a standard infection prophylaxis regimen or the standard regimen in addition to alcohol wash on the night prior to procedure and povidone-iodine 10 min prior to procedure. This study is notable for looking at a procedure that is analogous to sacral nerve stimulator placement and demonstrating that more rigorous skin preparations beginning the night prior to surgery can reduce the incidence of infection.

  22. •• Townley WA, Baluch N, Bagher S, Maass SWMC, O’Neill A, Zhong T, et al. A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: a matched cohort study. J Plast Reconstr Aesthet Surg. 2015;68(5):673–8. This is a retrospective study comparing infection incidence in patients undergoing implant-based breast reconstruction. This study is notable for finding no difference in infection incidence between patients who were given post-operative antibiotics and patients who were managed with a standard perioperative antibiotic regimen.

    Article  PubMed  Google Scholar 

  23. Clayton JL, Bazakas A, Lee CN, Hultman CS, Halvorson EG. Once is not enough: withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of infection. Plast Reconstr Surg. 2012;130(3):495–502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. •• Senaratne JM, Jayasuriya A, Irwin M, Gulamhusein S, Senaratne MPJ. A 19-year study on pacemaker-related infections: a claim for using postoperative antibiotics. Pacing Clin Electrophysiol. 2014;37(8):947–54. This is a retrospective study that included data from 3253 cardiac pacemaker implantations occurring over a period of 19 years. This study is notable for demonstrating reduced risk of infection with the use of post-operative antibiotics.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The journal would like to thank Dr. Howard Goldman and Dr. Gopal Badlani for providing the topic and review of this article.

Author information

Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Calvin Lee & Sandip P. Vasavada

  2. Department of Urology, Cleveland Clinic Foundation, Q10-1, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Javier Pizarro-Berdichevsky, Marisa M. Clifton & Sandip P. Vasavada

  3. Urogynecology Unit, Hospital Dr. Sotero del Rio, Santiago, Chile

    Javier Pizarro-Berdichevsky

  4. Division de Obstetricia y Ginecologia, Pontificia Universidad Catolica de Chile, Santiago, Chile

    Javier Pizarro-Berdichevsky

Authors
  1. Calvin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Pizarro-Berdichevsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marisa M. Clifton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandip P. Vasavada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandip P. Vasavada.

Ethics declarations

Conflict of Interest

Calvin Lee and Marisa M. Clifton each declare no potential conflicts of interest.

Javier Pizarro-Berdichevsky reports travel expenses covered by Medtronic for IUGA 2016.

Sandip P. Vasavada reports personal fees from Medtronic and Axonics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, C., Pizarro-Berdichevsky, J., Clifton, M.M. et al. Sacral Neuromodulation Implant Infection: Risk Factors and Prevention. Curr Urol Rep 18, 16 (2017). https://doi.org/10.1007/s11934-017-0663-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-017-0663-1

Keywords

Search

Navigation