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At least 595 records · Page 33Linked to original sources
PubMed2005

Prolonged sacral neuromodulation testing using permanent leads: a more reliable patient selection method?

OBJECTIVE: To assess the effect of prolonged sacral neuromodulation testing using permanent leads comparing the usual evaluation period of 4 to 7 days to a prolonged evaluation period of a minimum of 14 days. PATIENTS AND METHODS: A consecutive series of 20 patients (16 females and 4 males) undergoing prolonged sacral neuromodulation testing using permanent leads between September 2000 and March 2004 were evaluated retrospectively. 10 suffered from urgency-frequency syndrome, 3 from urge incontinence and 7 from non-obstructive chronic urinary retention. Key bladder diary variables at baseline, after the usual and prolonged evaluation period and at the last follow-up were compared. RESULTS: The median age was 52 years (interquartile range (IQR) 38-59) and the median evaluation period 28 days (IQR 18-29). 16 of the 20 patients (80%) had successful prolonged sacral neuromodulation testing and underwent the implantation of the IPG that was placed in the anterior abdominal wall in 6 and in the upper buttock in 10 patients. The eligibility for IPG implantation was significantly (p=0.031) increased from 50% after the usual to 80% after the prolonged evaluation period. At a median follow-up of 22 months (IQR 12-34), sacral neuromodulation was successful in 14 (88%) of the 16 IPG implanted patients but failed in 2. CONCLUSIONS: Prolonged sacral neuromodulation testing using permanent leads is more reliable for accurate patient selection than the usual evaluation period. Therefore, this method is strongly recommended and suggested to become the standard test procedure.

Abdominal Wall↗
PubMed1976

Herpes zoster with dysfunction of bladder and anus.

Herpes zoster may give rise to dysfunction of bladder and anus. Mucosal lesions have been reported, and 7 cases are described with retention, loss of sensation, or incontinence. Sacral shingles is associated with sensory loss and flaccid detrusor paralysis. Lumbar shingles may cause retention, and zoster at higher levels can also damage the spinal cord. Recovery is usually complete. The implication for schemes of bladder innervation is discussed.

Aged↗
PubMed2001

Sacral nerve stimulation as a treatment for fecal incontinence.

BACKGROUND & AIMS: Sacral nerve stimulation is a proven therapeutic option for the treatment of some forms of urinary incontinence. Very recently, preliminary reports have given evidence for its efficacy in fecal incontinence (FI) too. METHODS: Since November 1998, 20 patients have been treated for severe FI. The cause of FI was mainly neurologic (n = 15), and was idiopathic in 5 patients. After temporary (subchronic) external stimulation over a period of 10-14 days, patients whose continence status improved underwent implantation of a permanent quadripolar lead and a subcutaneously implanted pulse generator. RESULTS: Acute (needle) testing revealed a positive pelvic floor response in 16 patients who underwent subsequent permanent implantation. The median number of incontinence episodes decreased from 6 episodes (3-15/21 days) to 2 (0-5/21 days). The time period of retention of a volume of saline causing an urge until definitive defecation was 2 minutes (range, 0-5 minutes) preoperatively and increased to 7.5 minutes (2-15 minutes) postoperatively. Results of preoperative and postoperative (3 months) anal manometry showed a statistically significant increase in maximal resting and squeeze pressures. CONCLUSIONS: Sacral nerve stimulation seems to be a new and promising modality for patients with certain types of FI in whom conventional treatment options have failed to achieve an improvement.

Adolescent↗
PubMed1989

Sacral epidural electrodes for voiding in the chronic spinal dog.

Recent reports have shown that electrical stimulation of the bladder wall or sacral nerves is effective for bladder management in the spinal cord injured (SCI) patient. However, less invasive methods are needed for electrode implantation. A modified percutaneous procedure for implanting needle electrodes in the sacral canal was evaluated. Stimulation with these electrodes were effective for inducing voiding with little residual volume after the recovery of bladder reflexes, 3 weeks after experimental spinal cord injury in the dog. An optimum electrode arrangement involved a single midline monopolar electrode located between sacral foramina L7 and S1. However, at low stimulating current, lateral electrodes adjacent to sacral nerves were more effective than midline electrodes for inducing voiding. Stimulation parameters that were effective for daily voiding were 10 pps, 1.5-5 mA, 0.3 ms pulse duration, and 2- to 3-second stimulation periods.

Animals↗
PubMed2001

SOX10 is abnormally expressed in aganglionic bowel of Hirschsprung's disease infants.

BACKGROUND: The primary pathology of Hirschsprung's disease (HD) is a congenital absence of ganglion cells in the caudal most gut. The spastic aganglionic bowel is often innervated by a network of hypertrophied nerve fibres. Recently, mutations of SOX10 have been identified in patients with HD but only in those with Waardenburg-Shah syndrome. AIMS: To understand the molecular basis for the pathogenesis of HD we intended to determine the specific cell lineages in the enteric nervous system which normally express SOX10 but are affected in disease conditions. METHODS: We studied colon biopsies from 10 non-syndromic HD patients, aged three months to four years, and 10 age matched patients without HD as normal controls. The absence of mutation in the SOX10 gene of HD patients was confirmed by DNA sequencing. Expression and cellular distribution of SOX10 in bowel segments of normal and HD infants were examined by reverse transcription-polymerase chain reaction and in situ hybridisation. RESULTS: We found that in normal infants and normoganglionic bowel segments of HD patients, SOX10 was expressed in both neurones and glia of the enteric plexuses and in the nerves among the musculature in normal colon. In the aganglionic bowel segments of patients, SOX10 expression was consistently lower and was found to be associated with the hypertrophic nerve trunks in the muscle and extrinsic nerves in the serosa. CONCLUSION: We conclude that SOX10 is normally required postnatally in the functional maintenance of the entire enteric nervous system, including neurones and glia. In non-syndromic HD patients who do not have the SOX10 mutation, the SOX10 gene expressed in the sacral region may be involved in the pathogenesis of the abnormal nerve trunks through interaction with other factors.

Case-Control Studies↗
PubMed1998

An animal model for the neuromodulation of neurogenic bladder dysfunction.

OBJECTIVE: To develop an animal model to examine the pathophysiology by which S3 sacral root electrostimulation alters the micturition reflex in patients with bladder hyper-reflexia. MATERIALS AND METHODS: Chronic sacral nerve root electrostimulation was applied to spinally transected rats; 21 animals were divided into four groups. The spinal cord was completely transected at the T10-11 level and stainless-steel electrodes implanted into the sacral foramen in 17 animals; these animals were subsequently divided into two groups (1 and 2). Six rats in group 1 underwent sacral root elctrostimulation for 2 h/day and five in group 2 for 6 h/day, for 21 days. The sham group (group 3, six rats) received no stimulation and four rats were used as healthy controls (group 4). Voiding frequency was recorded and each animal was evaluated cystometrically at the end of the stimulation period. The results were compared with the sham and control groups. RESULTS: Spinal cord transection resulted in bladder areflexia and complete urinary retention; 7-9 days after the injury, the bladder recovered its activity. Twenty-one days after transection all animals had evidence of uninhibited bladder contractions. The mean (SD) hourly frequency of urination was 0.66 (0.18) in healthy controls, 0.83 (0.21) in group 1, 0.87 (0.34) in group 2 and 1.1 (0.31) in group 3. There was a significant decrease in eh cystometric signs of bladder hyper-reflexia in groups 1 and 2 when compared with group 3. CONCLUSIONS: This work reports and initial study showing that chronic electrostimulation of sacral nerve roots can reduce the signs of bladder hyper-reflexia in the spinally injured rat. To our knowledge, this is the first report describing the rat as an animal model to determine the effects of chronic electrostimulation on the micturition reflex.

Animals↗
PubMed2005

Sacral neuromodulation for urinary retention in a kidney-transplant patient.

Bladder outlet obstruction can negatively affect renal function in the kidney transplant population. Functional obstruction represents a clinical challenge as conventional treatments are either ineffective or not recommended. Sacral neuromodulation was successfully used in functional voiding dysfunction in a kidney transplant patient. This is the first case to be reported in the literature.

Electric Stimulation Therapy↗
PubMed1992

The segmental distribution of afferent fibers from the vaginal cervix and hypogastric nerve in rats.

Injections of horseradish peroxidase-wheat germ agglutinin (HRP-WGA) into the walls of the vagina and cervix (vaginocervical injections) of rats resulted in labeling of dorsal root ganglia (DRG) cells located at T11-L4 and L6-S2. In a second group of animals, exposure of the hypogastric nerve to HRP-WGA resulted in a similar bimodal distribution of labeled cells as compared to vaginocervical injections. In a third group, unilateral hypogastric nerve transection prior to injection of HRP-WGA into the vaginocervical walls resulted in a significant reduction in DRG cells labeled at T13, L1, L2, L6 and S1. Bilateral transection of the hypogastric nerves prior to vaginocervical injections eliminated labeled DRG cells at thoracolumbar levels but not at L6 and S1. Bilateral pelvic neurectomy reduced, but did not eliminate labeled DRG cells at L6 and S1 following vaginocervical injections. These results indicate that the hypogastric nerve constitutes a major sensory pathway from the vaginocervical walls to thoracic, lumbar and sacral levels of the spinal cord. The hypogastric nerve may subserve the transmission of noxious input from the vaginocervical walls as well as the activation of ascending spinal pathways involved in neuroendocrine reflexes during parturition.

Afferent Pathways↗
PubMed2006

Sacral nerve stimulation for the overactive bladder.

Pharmacotherapy is the first-line treatment for overactive bladder, but many patients discontinue drug therapy because of intolerable side effects, expense, or lack of longterm adherence. Alternative treatments are needed for patients who are unable to tolerate pharmacotherapy or who do not derive the desired benefits. Sacral nerve stimulation therapy has evolved into one of the most widely accepted treatment modalities in the arena of neurourology. Sacral nerve stimulation activates or "resets" the somatic afferent inputs that play a pivotal role in the modulation of sensory processing for micturition reflex pathways in the spinal cord. This minimally invasive technology offers a safe, reliable, and durable treatment for lower urinary tract dysfunction.

Electric Stimulation Therapy↗
PubMed2002

Unilateral versus bilateral sacral neuromodulation in patients with chronic voiding dysfunction.

PURPOSE: Bilateral sacral nerve neuromodulation has been proposed as a more effective treatment for chronic voiding dysfunction. However no comparison with the unilateral approach has been performed. We investigated the possible advantage of bilateral sacral neuromodulation. MATERIALS AND METHODS: In a prospective randomized crossover trial we investigated 33 patients who underwent bilateral implantation of a temporary test lead. Unilateral and bilateral test stimulation was continued for 4 to 6 days in all patients. Patients were randomly assigned to start with bilateral or unilateral stimulation. Between the stimulation episodes a 2-day washout interval was scheduled. Voiding diaries were completed at baseline and during the entire stimulation period. Sacral x-rays were taken to confirm lead positioning or possible migration after implantation and at the end of the test stimulation period. After 10 days the temporary leads were removed and voiding diaries were analyzed. RESULTS: After stimulation sacral x-ray revealed test lead migration in 8 patients, leaving 12 patients with urge incontinence and 13 with voiding difficulty and urinary retention available for review. A statistically significant improvement in voiding parameters was seen during the test stimulation period. However no statistically significant improvement was seen due to bilateral stimulation compared to unilateral stimulation. Two patients with urinary retention only started voiding to completion during bilateral stimulation. CONCLUSIONS: Bilateral is in general not superior to unilateral sacral neuromodulation. However, in some individuals bilateral stimulation may be more effective in relieving symptoms. Therefore, if unilateral percutaneous nerve evaluation fails, a bilateral test should be considered.

Adult↗
PubMed2002

Medium-term results of permanent sacral nerve stimulation for faecal incontinence.

BACKGROUND: Anal sphincter surgery for faecal incontinence is associated with significant morbidity and a variable outcome. Sacral nerve stimulation may provide a good functional outcome with minimal morbidity. This paper reports the experience in a single centre over 5 years. METHODS: Fifteen consecutive patients (14 women), median age 60 (range 37-71) years, underwent temporary, and subsequent permanent, stimulation. All had incontinence to solid or liquid stool; the aetiology was obstetric injury (seven patients), scleroderma (four), idiopathic (two), fistula surgery (one) and repaired rectal prolapse (one). Median duration of symptoms was 6 (range 2-15) years. Clinical evaluation, endoanal ultrasonography, bowel diary, quality of life questionnaire (Short Form (SF) 36) and anorectal physiological testing were performed before and after stimulation. RESULTS: Continence had improved in all patients at median follow-up of 24 (range 3-60) months. Eleven patients were fully continent. Episodes of faecal incontinence decreased from median (range) 11 (2-30) per week before stimulation to 0 (0-4) per week after permanent stimulation (P < 0.001). Urgency improved in all patients (median (range) ability to defer less than 1 (0-1) versus 8 (1-15) min; P = 0.01). 'Social function' and 'role-physical' subscales of the SF36 improved significantly. Mean resting pressure (35 versus 49 cmH2O with temporary stimulation; P < 0.05) and squeeze pressure increment (43 versus 69 cmH2O with permanent stimulation; P < 0.01) increased. Rectal sensitivity to initial distension changed (mean 47 versus 34 ml air; P < 0.05). There were no major complications. CONCLUSION: Sacral nerve stimulation is a safe and effective treatment for faecal incontinence when conventional treatment has failed. There is minimal morbidity. The benefit is maintained in the medium term.

Adult↗
PubMed2001

[Prevention and management of severe hemorrhage during gynecological operations].

OBJECTIVE: To investigate the prevention and management of severe bleeding during gynecological operations. METHODS: A retrospective study of 85,505 gynecological operations from 21 hospitals in China during the period of 1990-1999 was analyzed. RESULTS: There were 683 cases with bleeding more than 1,000 ml during surgery, an incidence of 0.80% (range 0.07%-6.98%). Operation for removal of malignant ovarian tumor was the commonest cause of severe bleeding (42.31%); followed by cervical carcinoma (28.71%); endometrial carcinoma (16.11%). Only 6 transvaginal surgeries (0.88%) had severe bleeding. The most common site of bleeding was massive oozing from the raw wound surface, then the paracervical area (15.7%), around sacral ligament (12.14%). CONCLUSIONS: Advanced malignant tumors, tumors located at retroperitoneal or with extensive adhesion were the main causes of profuse bleeding during operation. Good surgical skill and well understanding of the pelvic anatomy are the basic key points for surgeons, and a supportive anesthesia is also important in reducing hemorrhage during operations. Once bleeding occurs, to stop the bleeding accurately and promptly by pressing, clamping, and suturing, and internal iliac artery ligation may be needed occasionally. Special attention should be paid to the hemostasis of the venous plexus of pelvic floor.

Adult↗
PubMed1987

Metastatic malignant glioma with resultant extradural compression of a sacral nerve root.

A patient with a malignant cerebral mixed oligodendroglioma-astrocytoma presented with a severe, painful S-1 radiculopathy. Neuroradiological examinations revealed an extradural soft-tissue mass compressing the first sacral nerve root. Spinal fluid examination and myelography gave no evidence of intradural disease. Surgery confirmed the presence of metastatic glioma compressing the S-1 nerve root. The tumor was entirely epidural in location. Mechanisms of dissemination are discussed.

Adult↗
PubMed1996

Applied anatomy and physiology of the feline lower urinary tract.

Paired ureters, urinary bladder, and urethra constitute the lower urinary tract. Oblique passage of ureters through the bladder wall results in compression of the distal ureter to preclude urine reflux. Ureters are anchored by longitudinal ureteral musculature that outlines the bladder trigone and extends into dorsal submucosa of the urethra as urethral crest. The urinary bladder can be divided into apex, body, and neck. The male urethra has penile and pelvic components, the latter is divisible into preprostatic, prostatic, and postprostatic regions. The muscle coat of the bladder-urethra forms three functional entities in craniocaudal series. These are the detrusor muscle (to effect voiding), internal urethral sphincter (smooth muscle for generating tonic resistance), and external urethral sphincter (striated urethralis m. for phasic and voluntary continence). The vesical neck is a transition region. It is part of the internal urethral sphincter by virtue of its histology and innervation, but it contains detrusor fascicles that pull it open during micturition. Viscous accommodation plus sympathetic reflex inhibition of the vesical wall allows the urinary bladder to greatly expand in volume with minimal increase of intravesical pressure, within limits. At low volumes continence can be maintained by passive resistive elements of the urethral outlet. As volume increases, sympathetic reflex activity is necessary for continence. The striated external urethral sphincter is reflexly contracted to counter abrupt elevations of intravesical pressure and to maintain continence voluntarily. The pelvic plexus conveys sympathetic and parasympathetic innervation to the urinary tract. The pudendal nerve supplies the urethra and urethralis muscle. Ureters are largely independent of innervation. Internal and external urethral sphincters are activated by spinal reflexes, sympathetic and somatic reflexes, respectively. Normal micturition (sustained detrusor contraction and sphincter inhibition) is a brainstem-driven reflex, involving a spino-bulbo-spinal pathway and a pontine micturition center that switches from urine storage to micturition. All of the reflexes depend on neural activity in tension mechanoreceptors of the bladder wall and sacral afferent fibers.

Animals↗
PubMed2005

Sacral neuromodulation for the treatment of refractory urinary urge incontinence after stress incontinence surgery.

OBJECTIVE: This study was undertaken to evaluate the response to sacral neuromodulation in women with refractory, nonobstructive urinary urge incontinence after stress incontinence surgery. STUDY DESIGN: We reviewed the medical records of women in whom sacral neuromodulation was performed for worsening or de novo urinary urge incontinence after a stress incontinence procedure. All patients had undergone preliminary test stimulation. Demographics, surgical and urogynecologic history, including bladder diary and pad weight test, and urodynamic parameters were evaluated. RESULTS: Of 34 women, 22 (65%) responded to the test stimulation and underwent permanent lead implant. There was no difference between responders and nonresponders with respect to type of stress incontinence surgery. Incontinence or urodynamic parameters were not different between responders and nonresponders. Factors that were predictive of a positive response were women aged less than 55 years (P = .01), the test stimulation performed within 4 years of the stress incontinence procedure (P = .01), and evidence of pelvic floor muscle activity (P = .03). CONCLUSION: Sacral neuromodulation is a viable option for the treatment of refractory urinary urge incontinence that occurs after stress urinary incontinence surgery. Older women with no pelvic floor activity who are remote from their incontinence surgery may have a suboptimal response.

Electric Stimulation Therapy↗
PubMed2004

Enteric nervous system patterning in the avian hindgut.

The enteric nervous system (ENS) is principally derived from vagal and sacral neural crest cells that migrate throughout the gastrointestinal tract before differentiating into neurons and glia. These cells form two concentric rings of ganglia and regulate intestinal motility, absorption, and secretion. Abnormalities of ENS development can lead to disorders of intestinal function, including Hirschsprung's disease. These disorders are generally limited to the distal hindgut, suggesting unique features to development of this region. This study characterized the normal spatiotemporal development of the ENS within the avian hindgut. Neural crest cells begin to populate the hindgut at E8, with patterning of both plexuses complete by embryonic day 9. Crest-derived cells arrive in the submucosal layer before the myenteric layer, as well as differentiate to a neuronal phenotype first. The cloaca demonstrates a unique pattern, characterized by a disorganized myenteric plexus and a flattened nerve of Remak. Detailed understanding of normal avian hindgut ENS development will allow better utilization of this model system to study abnormalities of the intestinal nervous system.

Animals↗
PubMed1994

Use of sacral reflex latency measurements in the evaluation of neural function of spinal cord injury patients: a comparison of neuro-urophysiological testing and urodynamic investigations.

Complete suprasacral spinal cord injury is followed by great changes in the neural control and function of the lower urinary tract. In the literature there is some controversy about the relationship between detrusor function and results of neurophysiological tests of sacral root conduction after the spinal shock phase. Therefore, we studied this relationship in a group of 73 patients with clinical as well as neurophysiological documented complete suprasacral spinal cord injury, and compared sacral reflex latency measurements (bulbocavernosus and urethro-anal reflexes) with detrusor function, documented by urodynamic investigation. A high incidence of sacral reflex latency abnormalities was found. Comparison of sacral reflex latencies with detrusor reflex activity showed a statistical significant correlation. No such relationship could be found between urodynamic characteristics of the detrusor in patients with detrusor hyperreflexia and sacral reflex latency measurements. We conclude that sacral reflex latency measurements can give an indication about the existence of reflex detrusor activity. On the other hand, these neurophysiological measurements do not provide a reliable indication of the detrusor function after complete spinal cord injury.

Adolescent↗
PubMed1994

An electromyographic study on the urethral rhabdosphincter in normal and chronically rhizotomized cats: analysis of electrical potentials evoked by sympathetic nerve stimulation.

To investigate functional aspects of sympathetic nerve influence on the urethral rhabdosphincter, we examined electrical potentials of the male feline rhabdosphincter evoked by hypogastric nerve (HGN) stimulation using electromyography. Hypogastric nerve stimulation (1 Hz) elicited electrical potentials of the rhabdosphincter in both normal and chronically rhizotomized cats. In normal cats, the evoked potentials were not affected by transection of the bilateral pudendal nerves. The amplitudes of the evoked potentials were significantly larger in rhizotomized cats (p < 0.001), while the threshold stimuli and latency periods were not. These evoked potentials were prazosin- and atropine-resistant, but were abolished by hexamethonium and pancuronium in both groups. In normal cats, high frequency stimulation (10 to 20 Hz) of the HGN increased the activity of the rhabdosphincter when the bladder was empty, but not when the bladder was full enough to trigger the vesicourethral relaxation reflex. This excitatory effect of HGN stimulation was blocked by prazosin. These data suggest that the potential of the rhabdosphincter evoked by HGN stimulation (1 Hz) is produced through synapse from sympathetic preganglionic to cholinergic postganglionic neurons, and that, after sacral rhizotomy, cholinergic postganglionic terminals form more effective functional connections to somatically denervated motor end-plates of the rhabdosphincter. The sympathetic nerve is also believed to play a role in modulating urethral afferent activities through action on urethral smooth muscle.

Animals↗