Subcapsular relocation for sacral neuromodulation pulse generator implant revision

Objectives: We describe our technique and experience with subcapsular placement of the Interstim (Medtronic, Minneapolis, MN, USA) pulse generator in cases of revision for implant site pain. Methods: The pulse generator and electrode are carefully exteriorized and the floor of the capsule is incised. The system is placed beneath the floor of the original capsule, which then becomes the roof of the new pocket. A layered closure is performed. Results: Five patients have undergone the technique described with successful resolution of their pain. Conclusions Utilizing the capsule presumably improves defects in skin microcirculation, but also creates additional cushion superior to the pulse generator, helping to counteract the vertical mechanical forces of the pulse generator.