*2.2.9.4 Lead fracture and displacement*

Lead fracture, migration or dislodgement are a rare occurrence reported at around 1% of adverse events and eminent needs for device and lead replacements. The introduction of the tinned leads has aided in lowering the incidence of lead migration [41].

Patients may have, against better judgment and counseling, engaged electively in physically demanding exercises, or it may be the result of sudden acute movements or trauma. The result is a sudden loss of or major change in stimulation. On testing, high impedance (>4000 ohms) is found on all 4 electrodes [73]. Additionally, sacral x-ray imaging can help determine if any lead displacement or dislodgement is present. If evident, especially in the presence of complete loss of efficacy and all other alternative reprogramming efforts have been extorted, replacement of the lead is necessary, and sometimes contralateral placement or even bilateral stimulation may be needed, though the latter may not always prove successful [42, 71, 77].
