Jessica C Lloyd1, Bradley C Gill1,2,3, Javier Pizarro-Berdichevsky4,5, Howard B Goldman1,3. 1. Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. 2. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. 3. Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH, USA. 4. Urogynecology Unit, Sotero del Rio Hospital, Región Metropolitana, Chile. 5. Division de Obstetricia y Ginecologia, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Abstract
INTRODUCTION: Sacral neuromodulation (SNM) devices (Medtronic, Minneapolis, MN, USA) are not approved to undergo magnetic resonance imaging (MRI) of sites other than the head. When MRIs are required, devices are often removed prior to imaging. We reviewed the prevalence of device removal for MRI at a large academic institution and the subsequent clinical course of these patients. METHODS: A retrospective review of all SNM explants from 2009-2015 was performed. Cases explanted for MRI were analyzed to collect demographics, clinical characteristics, and postremoval management. Descriptive statistics were calculated. RESULTS: Ninety patients underwent SNM device removal, with 21 (23%) occurring for MRI. At explant, 20 patients (95%) were female and median age was 66 years. Suboptimal symptom control from SNM was noted in seven (33%) of these patients preoperatively. Of those explanted, six (29%) required MRI for neurologic and 10 (48%) for orthopedic concerns. The remaining MRI indications included abdominal masses (10%), genitourinary disease (5%), surveillance for prior malignancy (5%), and cardiac disease (5%). Only 16 (76%) patients explanted ultimately underwent MRI. MRI results impacted clinical management in 9/16 (56%) of the imaged patients. Only two (10%) of explanted patients underwent device replacement. CONCLUSIONS: In patients receiving SNM therapy, device removal for MRI is most commonly due to orthopedic and neurologic pathologies. About half of the MRIs performed impacted non-GU clinical management. It is of paramount importance to confirm the necessity of MRI before removing a functional SNM device. Since SNM replacement was rare in this cohort, research is needed on the safety of various MRI types with SNM devices in vivo.
INTRODUCTION: Sacral neuromodulation (SNM) devices (Medtronic, Minneapolis, MN, USA) are not approved to undergo magnetic resonance imaging (MRI) of sites other than the head. When MRIs are required, devices are often removed prior to imaging. We reviewed the prevalence of device removal for MRI at a large academic institution and the subsequent clinical course of these patients. METHODS: A retrospective review of all SNM explants from 2009-2015 was performed. Cases explanted for MRI were analyzed to collect demographics, clinical characteristics, and postremoval management. Descriptive statistics were calculated. RESULTS: Ninety patients underwent SNM device removal, with 21 (23%) occurring for MRI. At explant, 20 patients (95%) were female and median age was 66 years. Suboptimal symptom control from SNM was noted in seven (33%) of these patients preoperatively. Of those explanted, six (29%) required MRI for neurologic and 10 (48%) for orthopedic concerns. The remaining MRI indications included abdominal masses (10%), genitourinary disease (5%), surveillance for prior malignancy (5%), and cardiac disease (5%). Only 16 (76%) patients explanted ultimately underwent MRI. MRI results impacted clinical management in 9/16 (56%) of the imaged patients. Only two (10%) of explanted patients underwent device replacement. CONCLUSIONS: In patients receiving SNM therapy, device removal for MRI is most commonly due to orthopedic and neurologic pathologies. About half of the MRIs performed impacted non-GU clinical management. It is of paramount importance to confirm the necessity of MRI before removing a functional SNM device. Since SNM replacement was rare in this cohort, research is needed on the safety of various MRI types with SNM devices in vivo.
Authors: Kevin Benson; Rebecca McCrery; Chris Taylor; Osvaldo Padron; Bertil Blok; Stefan de Wachter; Andrea Pezzella; Jennifer Gruenenfelder; Mahreen Pakzad; Marie-Aimee Perrouin-Verbe; Philip Van Kerrebroeck; Jeffrey Mangel; Kenneth Peters; Michael Kennelly; Andrew Shapiro; Una Lee; Craig Comiter; Margaret Mueller; Howard Goldman; Felicia Lane Journal: Neurourol Urodyn Date: 2020-04-27 Impact factor: 2.696
Authors: Marcelo Mass-Lindenbaum; D Calderón-Pollak; H B Goldman; Javier Pizarro-Berdichevsky Journal: Int Braz J Urol Date: 2021 May-Jun Impact factor: 1.541