Radiation Exposure During Sacral Neuromodulation Lead Placement: Multi-Institutional Descriptive Study

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Conference Proceeding

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Journal of Urology


INTRODUCTION AND OBJECTIVE: Fluoroscopy has significantly improved lead placement and decreased surgical time for implantable sacral neuromodulation. Despite the Food and Drug Administration public health advisory encouraging physicians to limit the use of fluoroscopy, there is a paucity of data regarding radiation and safety of fluoroscopy during SNM procedures. The aim of our study is to characterize fluoroscopy time and dose used during SNM surgery .METHODS: Electronic medical records were queried for SNM procedures (Stage 1 and full implant) from 2016-2021 at three academic institutions. Demographic, clinical and intra-operative data and were collected, including fluoroscopy time and radiation exposure in milligray (mGy). The data was entered into a centralized REDCap database. Statistical analyses were performed using STATA/BE 17.0.RESULTS: 524 procedures were performed across three institutions. 456 were Stage 1 lead placement and 68 were full implants.358 (68.3%) procedures had fluoroscopy details recorded. Mean surgical time was 49.2 minutes ±16.8(SD). The mean fluoroscopy time was 46.1 seconds ±48.9(SD) and mean dosimetry was 36.8mGy ±46.1(SD). Of all procedures, 80.5% were completed by general urologists and urology-trained Female Pelvic Medicine and Reconstructive Surgery(FPMRS) specialists. Surgical specialty was significantly predictive of time and dose with FPMRS-trained urologists utilizing the lowest of both (p<0.001, Table 1). The presence of trainees significantly increased fluoroscopy time. Bilateral lead placement also significantly increased both dose and time. On multivariate analysis for fluoroscopy time, both the placement of bilateral leads and FPMRS-trained urologists had a statistically significant impact (p<0.001). CONCLUSIONS: Fluoroscopy practices in SNM procedures include significant variability in cumulative radiation dose and time based on multiple factors. These findings demonstrate the need for standardized radiation and fluoroscopy training across specialties who perform SNM procedures





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American Urological Association Annual Meeting, April 28 - May 1, 2023, Chicago, IL