Presentation
Pelvic pain. Known case of hyperactive urinary bladder.
Patient Data
A sacral nerve stimulation (SNS) device is seen in place; its pulse generator is noted in the subcutaneous soft tissues of the right buttock and its electrode lead can be followed from the pulse generator traversing the subcutaneous tissues of the back and entering the left sacral foramen at S4 level with its tip lying in a pre-sacral location at S5 level. No signs of infection (fat stranding, free fluid, or collection) are seen in the soft tissues around the pulse generator. Coarse calcifications are noted in the prostate gland. No suspicious osseous lesion is seen in the visualized skeleton.
Frontal and lateral views of the sacrum acquired at the time of the fluoroscopic guided insertion of the sacral nerve stimulator.
Case Discussion
Sacral neuromodulation or sacral nerve stimulation (SNS) devices are used to treat symptoms related to defecation and voiding 1. These devices had also been used in the management of pelvic pain syndromes (e.g. pudendal neuralgia) 1. Among the patients with bowel and/or bladder complaints managed with sacral neuromodulation, approximately 90% patients reported symptomatic improvement 2. Infection, device migration, and lead fracture are the common complications associated with these devices which can be diagnosed with imaging 1. Lead fracture and device migration can be diagnosed with plain radiography whereas cross-sectional imaging (i.e. CT or MRI) are helpful in evaluation of suspected infection 1,3.