BERKELEY, CA (UroToday.com) - Since the time of completion of the "Randomized prospective crossover study of InterStim lead wire placement with curved versus straight stylet," we have adopted almost exclusive use of the curved stylet for InterStim lead wire placement in our University of California, Irvine practice, based upon study results. If unsatisfactory responses occur with the curved stylet, the straight stylet will then be trialed — however, this is only necessary in a minority of cases. We encourage others to increase their comfort level in initiating placement with the curved stylet, as we are confident that in the majority of cases, it will provide superior lead wire placement. Unfortunately the lead wire still arrives with the straight stylet in place, and I think many are hesitant to make the exchange. In response to that potential barrier, we are developing an educational video to illustrate the use of the curved stylet—the interchange required, and the advantages of redirecting and repositioning abilities.
Furthermore, while published in our paper, some of the greatest value of our results reaches beyond the primary outcomes. Mainly, the fact that among all patients who had trials of both, the vast majority (88%) had superior placement with the curved stylet, again supporting that it is more advantageous to trial this first and only if unsuccessful, move to use of the straight. Additionally, 8 patients of our 40 had no response at the 0 electrode with the straight stylet even at maximum stimulation—2 of whom were also lacking a response at the 1 electrode. If this were the final placement in these patients, programming options would subsequently be quite limited. The curved stylet, which can be redirected and repositioned, was able to achieve response at these 0 and 1 electrodes in all of our study patients. So not only are responses occurring at lower amplitudes (our primary outcome), but a successful response, in general, at each electrode was more consistent with the curved stylet.
In the future, research goals persist to compare postoperative outcomes and amplitude requirements between the curved and straight stylet use. Until then, the clearly superior intra-operative results with the curved stylet continue to fuel our confidence in and encouragement of its use.
Written by:
Stephanie A. Jacobs, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Division of Urogynecology, University of California, Irvine, Orange, CA USA
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