Introduction: Sacral neuromodulation is an FDA approved treatment for overactive bladder. Efficacy depends on correct lead placement. The optimal lead placement technique uses real-time fluorosocpy to place the the sacral neurostimulator lead into the most superior and medial aspect of the S3 foramen. Here, we seek to provide guidance on using the optimal lead placement technique. Methods: Using a recent sacral neurostimulator implant as an example case, we outline the critical steps and key teaching points for sacral neurostimulator implant. Results: Optimal lead placement technique is demonstrated within the video. The patient is positioned in swimmer's position. Real time fluoroscopy is used to identify the most medial aspect of the sacral foramina, and then to guide the entry point of the introducer needle such that it is parallel to the bone seam. This lead placement maximizes stimulation of S3 sacral nerve roots while minimizing stimulation of S2 and S4 nerve roots. In an ideally placed lead, bellows response occurs before toe response. The lead is tested prior to full implant. Conclusions: Correct patient positioning and knowledge of target anatomy is key the optimal lead placement technique. Optimal lead placement technique uses real time imaging to place lead precisely, leading to improved clinical outcomes. This also increases the efficiency of lead placement, leading to faster operative times and increased cost-savings. SOURCE OF Funding: None
