Axonics 1901 PNE Lead Manual Del Usario página 13

Figure 4 . Connect needle test stimulation cable to the foramen needle.
3. Using the CP (outside the sterile field), gradually increase the stimulation amplitude to obtain appropriate S3
motor and/or sensory response (Table 2).
Motor response
Nerve Pelvic Floor
S2
Potential clamp response
(anterior-posterior contraction
of the perineal structures; a
clamp-like contraction of the
anal sphincter, and in males, a
retraction of the penis base).
S3
Bellows (flattening and
deepening of the buttock
groove due to the lifting and
dropping of the pelvic floor).
S4 Bellows
4. Observe the patient's motor responses to stimulation.
5. Ask the patient to describe the sensation of the stimulation. Also include the location (pelvic floor, vagina,
testes, rectum/anus, bladder, scrotum, etc.) and quality (pulling, tapping, etc.) of the sensation.
6. Use the CP to reduce the stimulation amplitude to zero once appropriate responses are noted.
7. If the desired responses are not seen, reposition the needle higher and more medially in the foramen and/or change
the angle of the needle as deemed appropriate. If the response is still not as desired, test at one foramen level above
or below. Testing the contralateral side should also be considered as this may also improve the response.
Note: Due to anatomical variations in nerve location, the appropriate nerve responses may be seen at different
foramen levels.
8. When testing is complete, decrease the stimulation amplitude to zero and disconnect the needle test stimulation
cable from the needle.
PNE lead placement
1. Remove the stylet from the foramen needle (Figure 5).
Table 2 . Motor and sensory responses to sacral nerve stimulation
Leg/Foot
Rotation of the leg/hip rotation,
rotation of the heel, calf
contraction.
Flexing great toe, occasionally
flexing of other toes.
None
Figure 5 . Remove the stylet from the foramen needle.
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Sensory response
Generally none or may have a
sensation in the buttocks.
Pulling in rectum, extending
forward to scrotum or labia.
Pulling in rectum