Nerve Evaluation

Before placement of the permanent pulse generator, it is useful to evaluate the sacral nerve to assess its suitability for stimulation. The purpose is to confirm the integrity of the peripheral nerves. Also, it can identify the optimal site for a trial of temporary stimulation. This may be performed by one of two methods - percutaneous nerve evaluation (PNE) or staged implantation of the permanent lead. We use the PNE in patients who have urgency and frequency. Patients who are being treated for nonobstructed urinary retention generally undergo a staged procedure. This allows for a longer period of evaluation, because retention generally improves over a week to 10 days, whereas with urgency and frequency, the results are generally apparent within several days. The advantages of the PNE are that it is performed as an office procedure, it is completely percutaneous, and the wires can be removed simply by pulling them out. The drawbacks are that lead migration occurs in 12% of patients and there is a potential difference of approximately 15%, in clinical response when the permanent lead is placed with the internal pulse generator. The advantage of the staged procedure is that the permanent lead is placed during the first stage; therefore, the clinical response when the internal pulse generator is inserted is the same, because lead migration is minimal. The disadvantages are that a small open incision is needed to implant the lead, and a separate procedure is necessary to explant the lead should the test period be unsuccessful.

Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

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