NEUROGENIC bladder, a condition caused by damage to the nervous system that controls urination, can lead to incontinence, urgency, frequency, and retention, severely affecting patients’ quality of life. Sacral neuromodulation (SNM) is an established treatment involving electrical stimulation of the sacral nerves through implanted electrodes, improving bladder function. However, surgical challenges arise in patients with pelvic structural anomalies, where traditional X-ray guidance for electrode placement increases radiation exposure and prolongs surgery.
A recent study introduced a novel approach combining preoperative 3D printing with intraoperative ultrasound-guided puncture to address these challenges. This method offers a safer and more precise alternative, reducing X-ray exposure for patients and healthcare staff while enhancing surgical outcomes.
SNM targets sacral nerves S3-S4 to stimulate bladder and urethral muscles. Successful outcomes rely on accurate electrode placement, which can be complex in cases of pelvic anomalies. Traditional X-ray methods, although effective, expose patients to radiation and prolong the procedure. Advanced imaging techniques, including O-Arm navigation and CT guidance, have improved accuracy but still involve radiation risks.
Preoperative 3D printing creates a detailed model of the patient’s pelvic anatomy, allowing surgeons to simulate the procedure and determine the ideal puncture site in terms of angle, position, and depth. Intraoperative ultrasound complements this by guiding the needle placement in real time, avoiding the limitations of ultrasound-alone methods, which often struggle with electrode depth localisation.
In a study of 56 patients with neurogenic bladder and complex pelvic anatomy, the use of 3D printing and ultrasound significantly reduced puncture attempts, surgery time, and intraoperative adjustments compared to traditional X-ray methods. Patients in the study group also experienced lower initial effective voltages, indicating more accurate electrode placement.
This innovative approach significantly enhances surgical precision and reduces radiation exposure, however, the cost of 3D printing may pose an economic challenge for patients. Despite this, the method represents a significant step forward in treating neurogenic bladder, particularly for patients with complex pelvic conditions.
Katie Wright, EMJ
Reference
Liu R et al. Effectiveness of sacral neuromodulation with 3D printing and ultrasound localization for treating neurogenic bladder in patients with pelvic structural anomalies. Asian J Surg. 2024;DOI:10.1016/j.asjsur.2024.10.153.
