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PubMed1997

The relationship of lumbosacral plexus to the sacrum and the sacroiliac joint.

The lumbosacral plexus was dissected bilaterally in 20 adult cadavers to define the anatomic relationship of the lumbosacral plexus to the sacrum and the sacroiliac joint. All results are mean values +/- standard deviation. The length of the nerve roots of the lumbosacral plexus gradually decreased from L-4 to S-3 (from 93.8 +/- 6.9 mm in males and 108.7 +/- 7.7 mm in females at L-4 to 43.7 +/- 4.3 mm in males and 49.0 +/- 7.6 mm in females at S-3). The angle projected by the nerve roots of the lumbosacral plexus with respect to the sagittal plane gradually increased from L-4 to S-3 (from 14.3 degrees +/- 3.4 degrees in males and 16.7 degrees +/- 4.8 degrees in females at L-4 to 51.8 degrees +/- 9.0 degrees in males and 57.8 degrees +/- 9.1 degrees in females at S-3). The width of the nerve roots of the lumbosacral plexus was greatest at S-1 (9.8 +/- 1.8 mm in males, 8.6 +/- 1.5 mm in females). The L-5 nerve root was the thickest in males (4.4 +/- 0.5 mm), and the S-1 nerve root was thickest in females (4.3 +/- 0.4 mm). The lumbosacral trunk was 30.0 +/- 9.0 mm in length in males and 32.0 +/- 6.0 mm in females; 11.4 +/- 1.8 mm wide in males and 11.2 +/- 1.5 mm in females; and 4.4 +/- 0.5 mm thick in males and 4.0 +/- 0.6 mm in females. The fifth lumbar nerve root and lumbosacral trunk coursed across the sacroiliac at a level 2.0 +/- 0.2 cm below the pelvic brim and were relatively fixed to the sacral ala with fibrous connective tissue.

Aged↗
PubMed2002

Sacral neuromodulation for the treatment of bladder dysfunction.

S3 nerve root neuromodulation is becoming an accepted therapy for individuals afflicted with lower urinary tract symptoms, such as idiopathic urinary urge incontinence, frequency, urgency, and urinary retention, who fail current standard therapies. This patient population is difficult to treat, and this therapy offers an option that can restore quality of life to these individuals. While the precise pathophysiologic mechanisms underlying these voiding symptoms is unknown based on the physiology of bladder function, it is logical to conclude that they relate to some aberration of the neuromuscular apparatus of the bladder and/or its outlet (the urethra). These pathophysiologic defects are not overtly manifested outside the lower urinary tract because these patients routinely do not have any apparent neurologic deficits. The fact that S3 neuromodulation can clinically improve these lower urinary tract symptoms would support the notion that the neural regulation of the bladder is somehow altered in these patients. This paper presents a review of the current knowledge regarding sacral neuromodulation in treatment of non-neurogenic voiding dysfunction.

Electric Stimulation Therapy↗
PubMed1997

Neuropathology of autonomic nervous system in Parkinson's disease.

Lewy body formation has been considered to be a marker for neuronal degeneration, because postmortem studies of Parkinson's disease (PD) patients have shown loss of neurons in the predilection sites for Lewy bodies. We systemically studied the autonomic nervous system in patients with PD. Lewy bodies were widely distributed in the hypothalamus, sympathetic system (intermediolateral nucleus of the thoracic cord and sympathetic ganglia) and parasympathetic system (dorsal vagal and sacral parasympathetic nuclei). The number of neurons in the intermediolateral nucleus was significantly reduced. Furthermore, Lewy bodies were also found in the enteric nervous system of the alimentary tract, cardiac plexus, pelvic plexus and adrenal medulla. These findings indicate that both central and peripheral autonomic nervous systems are involved in the disease process in PD.

Autonomic Nervous System Diseases↗
PubMed1987

[Arterial and neural pedicles of the anorectal region in the human embryo and fetus. Inductor role in normal and pathological development].

To gain a better understanding of the development of ano-rectal malformations, a study of the arterial supply of the ano-rectal region was made in 26 human embryos and fetuses. The development of the ano-rectum was studied in 20 embryos, varying in length from 3 mm to 40 mm (Crown-Rump: 22-60 days), and 6 using Born's method reconstruction; 10 fetuses aged from 3 to 7-8 months were used for a topographic study of the ano-rectal region. 40 fetuses, the majority frozen after expulsion were injected immediately. The fetuses obtained were of ages corresponding to 12-39 weeks of amenorrhea. A staged histologic study after selective micropaque injections of the inferior mesenteric artery was carried out to demonstrate the arterial parietal distribution in the ano-rectum. Smith silver impregnation method, emphasizes the connections between the rectal arteries and extrinsic and intrinsic nerves. The subdivision of the cloaca is constituted by the folding of the ano-rectal and uro-genital parts and by the thickening of the dorsal cloacal epithelium, explained perhaps by the precocious development of arterial supply. The superior rectal artery is predominant and supplies the whole of the anorectum, eventually penetrating the wall of the anal canal. The well-developed median sacral artery is surrounded by a nervous tissue which reaches the M. Levator Ani. The sympathetic nerve fibers follow the arteries until the submucous layer. The development of the intramural plexus of the rectum is independent of the arterial supply.(ABSTRACT TRUNCATED AT 250 WORDS)

Anal Canal↗
PubMed1993

[Electrostimulation of the urinary bladder].

The authors present their first results with urinary bladder stimulation in dogs by using an electronic stimulator and electrodes of their own construction. Neurostimulation was carried out by means of contactless application of electrical rectangular pulses with the voltage ranging from 1 to 10 volts, frequency from 10 to 300 Hz and pulse with 1 ms. Due to the stimulation of the branches of the pelvis plexus an isolated contraction of the bladder detrussor with an increase of intravesical pressure up to 65 cm H2O was observed with subsequent spontaneous voiding. The stimulation of the intact sacral root S2 led to detrussor-sphincteric dyssynergia caused by simultaneous contraction of the detrussor and the striated urethral sphincter. The poststimulus spurt of urine was observed at the end of each S2 stimulation. The authors inform about the further plan of experimental work before introducing the method into clinical practice. (Fig. 4, Ref. 17.).

Animals↗
PubMed1989

A model for aganglionosis in the chicken embryo.

We investigated the ability of neural crest (NC) cells to colonize hindgut, which had remained aneuronal due to bowel transection in ovo at an early stage. The fact that the bowel remained aneuronal proved that the "sacral" NC does not provide precursor cells for enteric neurons in the hindgut. HNK-1 immunostaining of aneuronal hindgut revealed cell-free, ganglionic structures at the site of the myenteric plexus and a sub-population of mesenchymal cells in the submucosa. We cocultured this particular type of aneuronal bowel with the vagal neural anlage of either quail or chick embryos on the chick chorioallantoic membrane. After 1 week coculture, it appeared that NC cell colonisation of the hindgut had taken place, although there was a difference between the quail-chick and chick-chick model. Quail NC cells had given rise to submucous plexuses and some myenteric plexuses. Chick NC cells had only colonised the submucous region. These findings indicate that the cell-free ganglionic structures hamper neural crest cell colonization in the myenteric region.

Animals↗
PubMed2003

New percutaneous technique of sacral nerve stimulation has high initial success rate: preliminary results.

OBJECTIVE: We report on the new technique of sacral nerve stimulation in the treatment of voiding dysfunction. This new technique is characterized by percutaneous approach to the sacral nerves resulting in minimally invasiveness of the procedure and the ability to have patient awake during the electrode placement. METHODS: Since December 1999, we prospectively evaluated patients who underwent this novel percutaneous technique approach. Thirty-two patients (10 male, 22 female, mean age 43 years) were included and no complications were reported. Average follow-up time was 11 months (range 2-25 months). Main elements of the new technique are also described. The needle is inserted into the sacral foramen to a desired location (usually S3) and metal stylet is then inserted through the needle. With metal stylet only in the foramen, two dilators are successively inserted and the chronic lead is placed through the plastic dilator. Only a very small skin incision is necessary to allow the anchor fixation. RESULTS: Out of the 32 patients who underwent the percutaneous lead placement, 22 received the neurostimulator (IPG). Out of the remaining 10 patients, 4 are still in screening and 6 had unsuccessful results (<50% improvement) and therefore did not undergo the second stage (neurostimulator placement). From the 22 implanted patients, 20 reported 90% improvement in their primary voiding symptoms, 1 had an improvement between 50 and 70% and 1 patient was explanted due to IPG damage following magnetic resonance imaging. There were total of four lead displacements, two occurred where the silicone anchoring was used and the other two occurred when no anchoring was done. CONCLUSION: Success rate of this technique in selecting patients for the permanent implant is significantly higher than currently reported in the literature. Very beneficial clinical outcome of the implanted patients confirms better patient selection with no complications. Our experience with this technique shows the feasibility of percutaneous lead placement with major advantages such as: (1) use of local anesthesia and possibility to test sensitive responses during implant, (2) the possibility for more accurate patient selection by using the definitive lead for a longer test period before proceeding with the neurostimulator (IPG) implant. The presented percutaneous technique requiring fascial lead fixation represents a safe and effective method of Sacral Neuromodulation Therapy.

Adult↗
PubMed1997

Posterior sacral rhizotomy and intradural anterior sacral root stimulation for treatment of the spastic bladder in spinal cord injured patients.

PURPOSE: The efficacy of intradural sacral posterior rhizotomy combined with intradural sacral anterior root stimulation in the treatment of the neurogenic hyperreflexic bladder was evaluated. MATERIALS AND METHODS: We reviewed 10 spinal cord injured patients who underwent surgery between September 1990 and February 1994. Bladder function was compared preoperatively and postoperatively. Intraoperative data on electrostimulation of the detrusor and striated muscles were analyzed. RESULTS: Stimulation of the anterior S3 and S4 roots was mostly used to empty the bladder (7 of 10 cases). Preoperative reflex incontinence disappeared in all patients postoperatively. Mean postoperative bladder capacity increases and mean postoperative post-void residual decreases were at least 340 ml. (p < 0.01) and 140 ml. (p < 0.01), respectively. Preoperative vesicorenal reflux disappeared in 2 and improved in 3 cases after sacral deafferentation. Autonomic hyperreflexia, which was present preoperatively in 6 patients, never disappeared but significantly improved after deafferentation. No major complications were noted postoperatively. CONCLUSIONS: Intradural sacral posterior rhizotomy combined with intradural sacral anterior root stimulation is a valuable method to treat the hyperreflexic bladder with incontinence resistant to conservative therapy in spinal cord injured patients. Autonomic hyperreflexia was decreased but not suppressed by posterior sacral rhizotomy.

Adolescent↗
PubMed1987

The autonomic innervation of Rana ridibunda intestine.

1. The innervation of Rana ridibunda intestine has been studied by the following methods: (a) demonstration of cholinesterase activity; (b) FIF method for catecholamines; (c) immunohistochemistry for VIP, SP and SOM, and (d) conventional electron microscopy. 2. The intrinsic intestinal innervation is represented by cholinergic-, VIPergic-, SP- and SOM-like plexuses. The intestinal adrenergic component is of extrinsic origin. 3. The intestinal peptidergic innervation is the most developed, the large intestine being the portion where the studied peptidergic plexuses are more widely distributed. 4. Against a poorly developed cholinergic/adrenergic innervation, it seems that there is a predominant peptidergic innervation in the amphibians intestine wall. 5. Taking into account that amphibians sacral parasympathetic as well as sympathetic innervation development are limited, it could be considered that in vertebrates the intestinal peptidergic innervation is phylogenetically earlier and hence better developed.

Adrenergic Fibers↗
PubMed2001

Quality of life assessment in patients who undergo sacral neuromodulation implantation for urge incontinence: an additional tool for evaluating outcome.

PURPOSE: We investigated the impact of sacral neuromodulation on quality of life and assessed the importance of quality of life for determining the success of sacral neuromodulation in patients with detrusor hyperactivity, including instability and hyperreflexia. We also compared it with parameters documented in a voiding diary. MATERIALS AND METHODS: From May 1998 to December 2000, 82 female and 31 male patients 17 to 79 years old (mean age 51.1) with urge incontinence (63), urgency/frequency (5), voiding disturbance (41) and pelvic pain (4) resistant to conservative treatment were enrolled in a national prospective registry after showing a positive response to percutaneous nerve evaluation testing. Of the patients 47 who were 32 to 79 years old (mean age 59.2) with urge incontinence due to detrusor instability and 16 who were 27 to 51 years old (mean age 51.5) with hyperreflexia were asked to complete a validated self-reporting incontinence domain specific quality of life questionnaire before, and 3, 6, 9, 12, 18, 24 and 36 months after implantation. RESULTS: Compared with baseline the quality of life index significantly improved at each followup, which strongly correlated with the decrease in the number of incontinence episodes. CONCLUSIONS: Evaluating quality of life may be an additional useful tool for assessing the results of sacral neuromodulation for urge incontinence. Our study confirms that sacral neuromodulation is effective therapy for urge incontinence that can have a positive effect on patient quality of life.

Adolescent↗