Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SACRAL PLEXUS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 469 records · Page 26Linked to original sources
PubMed2001

Sacral nerve stimulation for treatment of fecal incontinence: a novel approach for intractable fecal incontinence.

PURPOSE: Many patients with fecal incontinence demonstrate a functional deficit of the internal anal sphincter or the external sphincter muscles without any apparent structural defects. Few patients are amenable to repair or substitution of the sphincter. However, sacral nerve stimulation appears to offer a valid treatment option for fecal incontinence. The objectives of this study were: to evaluate the efficacy of temporary stimulation of the sacral nerve roots (percutaneous nerve evaluation) in patients with functional fecal incontinence; to determine the mechanisms of possible improvement; and to evaluate if temporary stimulation could be reproduced and maintained by implanting a permanent neurostimulation system. METHODS: Twenty-three patients with fecal incontinence, 18 females and 5 males, median age of 54.9 years (range 28-71), underwent a percutaneous nerve evaluation test. Eleven patients (47.8 percent) also had urinary disorders: urge incontinence (4), stress incontinence (3), and retention (4). Associated disorders included perineal and rectal pain (1), spastic paraparesis (1), and syringomyelia (1). All patients underwent a preliminary evaluation using stationary anal manovolumetry, pudendal nerve terminal motor latency measurements, and anal ultrasound. A percutaneous electrode for the stimulation of the sacral nerve roots was positioned at the level of the third sacral foramen (S3) in 20 patients and S2 in 2 patients (1 patient missing). Stimulation parameters used were: pulse width 210 microsec, frequency 25 Hz, and average amplitude of 2.8 V (range 1-6). The electrode was left in place for a minimum of 7 days. Five patients were successively implanted with a permanent sacral electrode with a stimulation frequency of 16 to 18 Hz and amplitude of 1.1- 4.9 V. RESULTS: Seventeen of the 19 patients (89.4 percent) who completed the minimum percutaneous nerve evaluation period of 7 days (median 10.7 (range 7-30)), had a reduction of liquid or solid stool incontinence by more than 50 percent, and fourteen (73.6 percent) were completely continent for stool. The most important changes revealed by manovolumetry were an increase in resting pressure (P < 0.001) and voluntary contraction (P = 0.041), reduction of initial pressure for first sensation (P = 0.049) and urge to defecate (P = 0.002), and a reduction of the rectal volume for urge sensation (P = 0.006). The percutaneous nerve evaluation results were reproduced at a median follow-up of 19.2 months (range 5 to 37) in the 5 patients who received a permanent implant. CONCLUSIONS: Temporary stimulation of the sacral roots (percutaneous nerve evaluation) can be of help in those patients with fecal incontinence, and the results are reproduced with permanent implantation. The positive effect on continence seems to be derived from not only the direct efferent stimulation on the pelvic floor and the striated sphincter muscle, but also from modulating afferent stimulation of the autonomous neural system, inhibition of the rectal detrusor, activation of the internal anal sphincter, and modulation of sacral reflexes that regulate rectal sensitivity and motility.

Adult↗
PubMed2000

Anorectal and bladder function after sacrifice of the sacral nerves.

STUDY DESIGN: The quantitative changes in anorectal and bladder functions after sacrifice of the sacral nerves were assessed. OBJECTIVES: To evaluate the bladder and anorectal functions before and after sacral nerve division in patients with sacral bone tumors. SUMMARY OF BACKGROUND DATA: The quantitative changes in bladder and anorectal functions after sacrifice of the sacral nerves have not been intensively studied. The purpose of this investigation was to measure the bladder and anorectal function before and after sacral nerve division using manometry and cystometry. METHODS: Surgical resection of a sacral tumor was performed in five patients. The sacral nerves were sacrificed bilaterally in three patients and unilaterally in two patients. Anorectal function was evaluated on the basis of symptoms and physiologic tests. Micturition function was evaluated based on symptoms, and intravesical pressures were measured by cystometry. RESULTS: The two patients with unilateral sacral nerve loss did not experience subjective problems with defecation or micturition, although the residual volume of urine was increased after surgery. Two of the three patients with bilateral sacral nerve loss had no urge to defecate, were unable to differentiate between feces and flatus, and experienced no urgency. Fecal incontinence was uncommon because of firm feces. It was possible to control defecation using enemas on alternate days. The third patient underwent colostomy because the maximum resting pressure, which is controlled by the hypogastric nerves, was affected before surgery. CONCLUSION: Unilateral sacrifice of sacral nerves results in little bladder or anorectal dysfunction.

Adult↗
PubMed2000

Sacral neurostimulation and neuromodulation in urological practice.

The problems associated with treating various forms of lower tract dysfunction by electrical stimulation are reflected in the many years of basic and clinical research in this area. However, better understanding of both neuroanatomy and neurophysiology, and development of new technologies have led to further application of electrical current to restore impaired bladder function. Contemporary knowledge of the potential for both sacral neurostimulation and neuromodulation as a therapeutic option for lower urinary tract dysfunction is reviewed.

Electric Stimulation Therapy↗
PubMedDate not supplied

Genitourinary applications of sacral neuromodulation.

Sacral neuromodulation provides a new option for the management of voiding dysfunction. For patients with intractable urge-incontinence, interstitial cystitis and non-obstructive urinary retention, this procedure has resulted in significant improvement in urinary frequency, voided volume and pelvic pain. We provide a review of the current literature on sacral neuromodulation and the West Virginia University experience with this procedure.

Electric Stimulation Therapy↗
PubMedDate not supplied

[Results of selective posterior radiculetomy at the lumbar and cervical level].

At the light of authors' present experience, radicletomy appears as an excellent antalgic operative procedure in the case of roots with high functional risk (brachial plexus and lumbar plexus). In the absence of any motor deficiency or ataxia, it appears that radicletomy is of help in the cure of severe hypertonies of the extremities (sequelae of cerebral stem contusions). Conversely, in the spastic sequelae of hemi- or paraparesias, lumbar-sacral posterior selective radicotomy is a sure procedure that procures results nearly super-imposable to radicletomy with an appreciable gain in time. At last, for what concerns the motor involvements of the upper extremity ending in spasticity, selective radicletomy recovers its rights and has to be preferred to S.P.R. The indications may be summarized as follows: -- At the level of the lower extremities: in the case of paraparetic sequelae or of sequelae due to spastic paraplegia, a S.P.R. has to be performed; for what concerns antalgic surgery, in the absence of motor deficiency, the best indication is radicletomy. -- At the level of the upper extremities: in the case of dystonic sequeale of the cerebral stem, spastic pain bound with hemiplegia or with carcinoma etc. (herpes zoster..), radicletomy constitutes the ideal surgical procedure.

Adult↗
PubMed2006

Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation.

PURPOSE: Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have failed. There have been several hypotheses concerning the mode of action of sacral nerve stimulation, but the mechanism is still unclear. This study was designed to evaluate the results of rectal volume tolerability, rectal pressure-volume curves, and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of sacral nerve stimulation. METHODS: Twenty-nine patients with incontinence (male/female ratio = 6/23; median age, 58 (range, 29-79) years) underwent implantation of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation test. Wexner incontinence score, rectal distention with thresholds for "first sensation," "desire to defecate," and "maximal tolerable volume," rectal pressure-volume curves, anal resting pressure, and maximum squeeze pressure were evaluated at baseline and at six months follow-up. RESULTS: Median Wexner incontinence score decreased from 16 (range, 6-20) to 4 (range, 0-12; P < 0. 0001). Median "first sensation" increased from 43 (range, 16-230) ml to 62 (range, 4-186) ml (P = 0.1), median "desire to defecate" from 70 (range, 30-443) ml to 98 (range, 30-327) ml (P = 0.011), and median "maximal tolerable volume" from 130 (range, 68-667) ml to 166 (range, 74-578) ml (P = 0.031). Rectal pressure-volume curves showed a significant increase in rectal capacity (P < 0.0001). The anal resting pressure increased significantly from 31 (range, 0-109) cm H(2)O to 38 (range, 0-111) cm H(2)O (P = 0.045). No significant increase in maximum squeeze pressure was observed. CONCLUSIONS: For patients with fecal incontinence successfully treated with sacral nerve stimulation, there was a significant increase in rectal volume tolerability and rectal capacity. A significant increase in anal resting pressure, but not in maximum squeeze pressure, was found. We suggest that sacral nerve stimulation causes neuromodulation at spinal level.

Adult↗
PubMed1980

Urethral sphincter activity following acute spinal cord injury.

We studied 44 patients with spinal cord injury during the first 72 hours after injury to determine the functional status of the bladder and external urethral sphincter. The studies included determination of the bulbocavernosus reflex, cystometry and sphincter electromyogram. In patients with lesions above the sacral cord the bulbocavernosus reflex was present. In nearly all of these patients the external sphincter activity increased with bladder filling. In all but 1 patient with injury to the sacral cord the bulbocavernosus reflex could not be elicited and the sphincter electromyogram did not increase with bladder filling.

Acute Disease↗
PubMedDate not supplied

Feasibility of implant driven micturition in paraplegic dogs.

OBJECTIVE: This study evaluates the feasibility of using existing technology for implant driven micturition in paralyzed dogs (part I) and also examines a less invasive technique for implant driven micturition (part II). STUDY DESIGN: Part I. Sacral nerve root dimensions and bladder and urethral pressure responses to intradural and extradural sacral nerve root stimulation were measured to determine the optimal location and size for sacral nerve root electrodes. Part II. Sacral nerve roots were stimulated via wire electrodes introduced into the S2 foramina. ANIMALS OR SAMPLE POPULATION: Ten dogs (five dogs in part I and five dogs in part II). METHODS: Part I. Microtip pressure transducers were used to monitor bladder and urethral pressure responses to sacral nerve root stimulation with tripolar hook electrodes. After euthanasia, sacral nerve root, and spinal canal dimensions were measured. Part II. Bipolar electrical stimulation of the sacral nerve roots was performed by introducing wire electrodes into the S2 foramina. Bladder and urethral pressures were recorded as in part I. RESULTS: Part I. Stimulation of SI produced an increase in urethral, but not bladder, pressure. Stimulation of S2 or S3 produced increases in bladder pressure and decreases in urethral pressure. Intradural and extradural nerve roots were not significantly different with respect to nerve dimensions or effects on nerve stimulation. Part II. High bladder pressures were achieved, but effective voiding could not be produced, primarily because of urethral resistance. CONCLUSIONS: Part I. Extradural implantation was determined to be the most appropriate site based on ease of dissection, nerve root dimensions, and decreased risk of iatrogenic trauma. Enough space is available to implant two to four tripolar spiral nerve cuffs. Part II. Transforaminal sacral nerve root stimulation did not effectively empty the bladder. CLINICAL RELEVANCE: Clinical trials in paraplegic dogs are necessary to evaluate the number of sacral nerve cuff electrodes necessary to produce effective bladder emptying.

Animals↗
PubMed1984

[Regulation of the anal canal pressure as revealed by myoelectrical activity of the internal anal sphincter].

Dogs were decerebrated under short-acting anesthesia and the intraluminal pressure within anal canal was continuously recorded through micro-balloon probe, simultaneously with myoelectrical activities of left and right internal anal sphincters. The rate of pressure 'ripples' was identical with that of 'slow spikes' recorded from the internal sphincters. When a transient drop in anal canal pressure was induced by rectal distension, observing the so-called 'recto-anal reflex', the 'ripples' in pressure and the 'slow spikes' of sphincters disappeared at once, and then, reappeared simultaneously in manometric and myoelectrical recordings at recovery phase of the reflex. It is concluded, therefore, that the 'slow spikes' of sphincters are directly coupled with mechanical responses of those muscles, and that the sustained contraction of internal sphincters maintains the pressure level and their temporary relaxation causes the pressure fall. The specific features of anal canal activity resulted by sacral denervation were seen on the chronic dogs kept alive over 20 days after nerve sections. The most remarkable ones were: prolonged inhibition of 'slow spikes' in the recto-anal reflex and marked formation of the reflex rebound. These findings indicate that not only inhibitory but also after-facilitatory processes in the reflex are potentiated in chronically denervated dogs. It is suggested that the myenteric neuronal circuit with lumbar sympathetic outflow have been re-organized under the condition of sacral denervation and those re-organized circuits are responsible for altered reflex pattern.

Action Potentials↗
PubMed2003

Surgical techniques for total sacrectomy and spinopelvic reconstruction.

The surgical management of sacral tumors requires partial or total sacrectomy and spinopelvic reconstruction. These lesions present a great surgical challenge, because most spine surgeons are unfamiliar with the techniques required for these procedures. The authors describe a step-by-step operative technique and provide several illustrations. Total sacrectomy is performed by sequential anterior and posterior approaches that involve a rectus abdominis pullthrough pedicle flap reconstruction. The anterior procedure is an intraperitoneal approach used to expose the anterior aspect of the tumor, to ligate the main tumor vessels, and to conduct an anterior partial sacrectomy. After this, the rectus abdominis myocutaneous flap, based on the inferior epigastric vessel, is prepared, and a posterior sacrectomy is performed, dividing all sacral nerve roots in the thecal sac. After complete en bloc extirpation of the sacrum with tumor, spinopelvic reconstruction and closure with a myocutaneous flap are performed. Spinopelvic reconstruction is undertaken using a modified Galveston technique or double iliac screw fixation combined with posterior lumbar segmental fixation. These provide a long lever arm within the ilium to counteract the forces exerted by the lumbar spine. Understanding the nature of the disease as well as the biomechanics of the lumbosacral pelvic area and spinopelvic fixation will help surgeons select the appropriate treatment for sacral tumors.

Biomechanical Phenomena↗
PubMed2006

Evaluation and management of malfunctioning sacral neuromodulator.

OBJECTIVES: To describe a strategy for revising the malfunctioning InterStim device and to provide an algorithm for evaluation and management. METHODS: We retrospectively reviewed 82 patients who had undergone InterStim placement. Ten patients (eight women and two men) experienced complications and subsequently underwent revision of their device between October 2001 and October 2003. Five patients had originally received a permanent implant after a successful percutaneous test stimulation trial, and five had undergone a test stimulation using the tined lead. Indications for revision included gradual onset of recurrent voiding dysfunction (n = 2), lead migration (n = 5), generator malfunction (n = 1), generator site pain and infection (n = 1), and genital/rectal pain with stimulation (sensory discomfort; n = 1). RESULTS: Of the 10 patients who underwent revision, 7 experienced complete resolution of their problem. Eight patients had lead site changes and two had generator replacements. No intraoperative or postoperative complications occurred in the revision cases. CONCLUSIONS: In our experience, 70% of patients who undergo revision of the malfunctioning InterStim can expect success. In this study, no difference in success appeared to be related to the original cause of malfunction. In the management of malfunctioning sacral neuromodulators, we recommend an attempt at revision before permanent explantation.

Algorithms↗
PubMed2006

[Chemical destruction of sacral nerve roots by alcohol injection for the treatment of overactive bladder].

INTRODUCTION: This study retrospectively reviewed the value of alcohol injection of sacral nerve roots after a lidocaine test in two indications: detrusor instability-detrusor hyperactivity syndrome and cystalgia. MATERIAL AND METHODS: Single-centre retrospective study from January 1992 to March 2003. Twenty-eight patients (1 man, 27 women) were admitted to the urology department for lidocaine test injection because of detrusor hyperactivity 24 cases (idiopathic = 13, neurological = 11), and cystalgia in another 4 cases. RESULTS: After the lidocaine test, infiltration of the sacral nerve roots (bilateral S3) by 70% alcohol was performed in 24/28 cases. The therapeutic effect was assessed at 1 month: 14 out of 24 patients reported that they were globally improved by the alcohol injection. The mean duration of the therapeutic effect was 3.8 months. In the longer term, only one of the 14 patients initially improved did not subsequently experience deterioration of the clinical features (with a follow-up of 8 months). A second alcohol injection was performed in 5/28 patients, with a positive result in only one case (4%). COMPLICATIONS: 6/24 (25%) patients developed lower limb pain that resolved over 2 to 3 months; 3/24 (12%) presented immediate postoperative urinary retention (that persisted in the long term in 1 case); 1/24 (4%) presented cicatricial anal incontinence. CONCLUSION: Alcohol injection of sacral nerve roots is a simple and inexpensive technique, but is associated with morbidity, and has inconstant and only transient effects. It can only be considered exceptionally in highly selected cases when no more effective treatments are available, such as botulinum toxin injection or sacral nerve root neuromodulation.

Adult↗
PubMed1977

Intraspinal sacral root stimulation for controlled micturition.

The intraspinal extradural segments of the sacral nerves were stimulated in an effort to obtain the combination of maximal detrusor contraction and minimal outflow resistance essential for effective micturition. Each root was stimulated unilaterally and bilaterally. In addition, each was separated into its motor and sensory components and these components were then individually stimulated. It was found that the most effective result was obtained with stimulation of root S2. As in the experimental animal, sacral roots in the human have a long intraspinal course that makes them accessible for implantation of electrodes. It is hoped that ongoing experiments will lead to the development of a chronically implantable sacral root electrode--thus providing a tool for efficient emptying of the denervated bladder.

Animals↗
PubMed1978

[Epidural systematic double-catheter venography in the diagnosis of lumbar disc herniation; mysterious vein in the vertebral canal (author's transl)].

Epidural venography should be regarded as a very accurate, relatively simple method of demonstrating disc herniations in the lumbar region. This procedure is especially recommendable in cases that are clinically suspect but have a negative or dubious myelogram. Systematic double-catheter venography has to be considered as an important addition to the existing diagnostic procedures for lumbar disc disease, especially when the more conventional methods have failed. This method should be considered at least as reliable as myelography, and even more reliable in the diagnosis of lateral disc herniations. However, small midline herniations may be missed. In some cases it is possible to detect a trapped root, not caused by a disc herniation. In our experience in 120 cases, systematic use of 2 catheters and simultaneous injection of contrast provides excellent, homogenous visualisation of the epidural venous plexus and surrounding veins. The reliability of the X-rays is definitely superior to the single catheter method. The Seldinger technique is used; the approach is via the right and left femoral vein. The cathetertips are selectively introduced from both sides either into a lateral sacral vein, an internal iliac vein or into a lumbar ascending vein. This can be performed as well on the homolateral or on the heterolateral side. This results in six possibilities from each groin, providing a fairly large number of procedures to obtain adequate filling of the epidural and surrounding veins. The position of choice of the cathetertip(s) can vary during the examination, dependent on diagnostic problems or technical catheterisation problems. The risk of complications is very small. It is possible to perform the examination on outpatients. The adequate demonstration of the epidural veins enables us to visualise frequently a small straight vein in the midline of the vertebral canal, that is unknown in the anatomical literature until now.

Epidural Space↗