Effectiveness of sacral neuromodulation with 3D-printing and ultrasound localization for treating neurogenic bladder in patients with pelvic structural anomalies

Abstract

Objective: To assess the efficacy and safety of Sacral Neuromodulation (SNM) in conjunction with 3D printing and ultrasound localization for treating patients with neurogenic bladder and pelvic structural anomalies. Methods: This prospective study involved 56 patients diagnosed with neurogenic bladder and pelvic anomalies. They were treated with SNM from January 2022 to December 2023. Patients were split into study and control groups based on the origins of their pelvic anomalies, with each group comprising 28 individuals. The study group underwent preoperative 3D printing and intraoperative ultrasound-assisted puncture, whereas the control group utilized intraoperative X-ray-assisted puncture. Metrics compared included the number of punctures, average puncture duration, intraoperative SNS tuning time, effective initial voltage, postoperative testing duration, phase two conversion rates, and the incidence of bleeding and infection. Results: The study group experienced significantly fewer punctures compared to the control group (2.21 ± 0.92 vs 9.29 ± 4.37) (P < 0.01), had a shorter average puncture duration (5.71 ± 2.69 min vs. 28.60 ± 9.69 min) (P < 0.01), and required a lower effective initial voltage (0.87 ± 0.23v vs. 1.38 ± 0.52v) (P < 0.01). X-ray exposure was eliminated in the study group, in contrast to 11.51 ± 4.62 mAs in the control group(P < 0.01). The phase two implantation rates were 67.8 % for the study group and 57.1 % for the control group(P = 0.04). No surgery-related complications occurred in either group. Conclusion: Combining preoperative 3D printing with intraoperative ultrasound-assisted puncture significantly improves the accuracy of SNM placement, reduces surgery time, and eliminates X-ray exposure for both doctors and patients. This method is both safe and effective for patients with neurogenic bladder and pelvic anomalies.

Keywords

• Neurogenic bladder
• Sacral neuromodulation
• 3D printing
• Pelvic structural anomalies