This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Implantable neurostimulators, adverse 
effects, hypersensitivity, urinary retention, 
therapy

None declared.

Patient Consent: Obtained.

Received on September 24, 2021 
Accepted on September 27, 2021

Soc Int Urol J.2021;3(1):44–45

DOI: 10.48083/NADE9605

FIGURE 1.

44 SIUJ  •  Volume 3, Number 1  •  January 2022 SIUJ.ORG

CLINICAL PICTURE

A Rare Case of Hypersensitivity Reaction Associated 
With Sacral Neuromodulation Hardware
Kendall A. Vignaroli,1 Shreeya Popat,2 Kathleen C. Kobashi2

1 Elson S. Floyd College of Medicine, Washington State University, Spokane, United States  
2 Department of Urology, Virginia Mason Franciscan Health, Seattle, United States

A 77-year-old female with history of lymphoma status 
post radiation therapy presented with approximately 
10 years of intermittent urinary retention, managed 
with clean intermittent catheterization. Urodynamic 
studies revealed minimal detrusor contraction (3 cm 
H2O) and a low amplitude, interrupted flow curve with 
maximum flow 9.5 mL/sec, average flow 2 mL/second, 
and appropriate EMG silencing. Cystoscopy was within 
normal limits. We proceeded with staged placement of 
Medtronic InterStim device. After stage 1 placement 
of the sacral neuromodulation device, the patient 
reported voiding larger volumes with less straining 
(an approximate 80% subjective improvement), denied 
further episodes of urinary retention, and her PVR 
improved from between 100 mL and 300 mL to 50 mL. 
However, she rapidly developed an erythematous skin 
reaction overlying the device lead (Figure 1). Physical 
examination revealed a discrete area of ery thema 
overlying the neuromodulation lead from percutaneous 
entrance to exit site. The initial differential diagnosis 
included infection versus inf lammatory response. 
Due to concern for infection, the device was promptly 

removed, at which time no purulence was noted along 
the course of the device components. Subsequent patch 
allergy testing revealed a strong reaction to vanadium, 
which is often used in titanium alloy, an external 
component of the InterStim implant. Both newer 
generation Medtronic and Axonics devices contain this 
titanium alloy; therefore, because of allergic intolerance 
to all available sacral neuromodulation devices, the 
patient’s urinary symptoms were subsequently managed 
with percutaneous tibial nerve stimulation. While there 
are documented cases of adverse events after sacral 
neuromodulation including device migration[1,2], 
device infection[3], and gluteal hematoma[4], to our 
knowledge there are no cases in the literature describing 
a hypersensitivity to sacral neuromodulation devices. 
The American Contact Dermatitis Society does not 
recommend preoperative hypersensitivity evaluation 
for patients undergoing hardware implantation but does 
recommend a risk-benefit analysis when considering 
device re-implantation in patients who demonstrate 
hypersensitivity to a metal implant[5].

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45SIUJ.ORG SIUJ  •  Volume 3, Number 1  •  January 2022

A Rare Case of Hypersensitivity Reaction Associated With Sacral Neuromodulation Hardware

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