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 685 records · Page 38Linked to original sources
PubMed2002

Assessment of sphincter muscle function before and after posterior sagittal anorectoplasty using a magnetic spinal stimulation technique.

PURPOSE: The authors used a magnetic spinal stimulation technique to assess both the preoperative sphincter function and the effect of operative intervention on the sphincter muscle in patients with anorectal malformations. METHODS: The authors examined 5 patients with an anorectal malformation consisting of 4 high-type cases and 1 intermediate-type case, that all had undergone posterior sagittal anorectoplasty during the previous 2-year period. Control data also were obtained from 11 age-matched healthy children. A contraction of the external anal sphincter (EAS) was evoked by magnetic stimulation of the sacral roots with a figure-of-eight coil at the level of the lumber and sacral segments. EAS electromyograms then were recorded at the anal verge. RESULTS: The preoperative motor latencies at L4 stimulation increased significantly more in the patients than in the controls (5.9 +/- 0.5 msec v 4.1 +/- 0.7 msec during left side recording). In the postoperative examination (1 to 5 months after operation), the mean maximum amplitude decreased slightly without any significant difference, where as the latency was almost identical to the preoperative data. CONCLUSION: These results suggest that the neurologic function of EAS was congenitally disturbed, and the current operative technique had no significant effect on the sphincter function.

Anal Canal↗
PubMed1995

Sacral (S3) segmental nerve stimulation as a treatment for urge incontinence in patients with detrusor instability: results of chronic electrical stimulation using an implantable neural prosthesis.

PURPOSE: We studied the effects of sacral (S3) nerve stimulation in patients with urge incontinence due to detrusor instability. MATERIALS AND METHODS: A permanent S3 foramen electrode was implanted in 18 patients (average age 46 years) who had shown a good response during temporary stimulation via a percutaneously placed wire electrode. Average followup was 29 months. RESULTS: The average voiding frequency and pad use per 24 hours decreased significantly. Improvement in several urodynamic parameters was noted. The correlation between symptomatic and urodynamic improvement was incomplete. CONCLUSIONS: Neuromodulation appears to be a valuable treatment option in these patients.

Adult↗
PubMed2003

Neural control of the internal anal sphincter motility.

Control mechanism of smooth muscle movement of the internal anal sphincter (IAS) by enteric and extrinsic neuvous systems in the dog was investigated. Responses of IAS muscle strips to electrical field stimulation (EFS) and neurotransmitter agents were recorded in vitro. The contraction response to norepinephrine or to EFS was inhibited by phentolamine. The relaxation induced by EFS was not affected by phentolamine, propranolol or atropine. The mechanical activity of smooth muscle in colon and anorectum during spontaneous defecation was recorded using strain gauge force transducers. The colon and anorectum showed the characteristic motility pattern during defecation: 1) The giant migrating contraction of the colon propagated to the rectum, 2) The relaxation of the rectum prior to the contraction, and 3) The IAS muscles continued to relax while the giant contractions of the colon were migrating to the rectum. Sacral nerves were stimulated electrically and the responses of smooth muscles in the rectum and IAS were recorded. The sacral nerve stimulation induced a relaxation followed by contraction of smooth muscle in the rectum and the relaxation in IAS. The mechanical responses of smooth muscle in the IAS were modulated by alpha-adrenergic excitatory and non-adrenergic, non-cholinergic inhibitory nerves. During defecation, the relaxation of IAS smooth muscle was associated with a characteristic motility pattern of the colon and anorectum. The enteric nervous systems may be organizing the motility of these muscles by way of the motor neurones under the control the extrinsic nervous systems.

Anal Canal↗
PubMed1975

[Urologic complications in rectal surgery (author's transl)].

Urinary disorders after amputation or resection of the rectum are much more frequent than commonly supposed. Out of 239 patients they were noticed by 56.6%, undergoing amputation, and 36.6% after resection. Longterm disturbances were observed by 26.4% respect. 15.1%. The most important reason is injury of autonomic pelvic nerves and ganglia. Urinary bladder infection was verified in 22% respect. 8%. Furthermore urinary disorders may be caused by changing of bladder localization (bladder hernia), wound infection (especially of the sacral cavity), edema of the urethra, and exacerbation or manifestation of pre-existing urologic diseases. Compared to these, lesions of the urinary tract are of little importance. To prevent such complications, we postulate: 1. careful pre-operative urologic examination, 2. if possible mobilisation of the rectum along its borderlines (so-called Grenzlamellen of Pernkopf), 3. critical analysis of urologic disorders, removal of the urinary catheter as soon as possible, regular systemic prophylaxis of urinary infection, and therapy controlled by antibiogram, 4. adequate follow-up, and 5. urologic examination of all disturbances lasting longer than three months.

Age Factors↗
PubMed1986

Origin of the parasympathetic preganglionic fibers to the distal colon of the rabbit as demonstrated by the horseradish peroxidase method.

The extrinsic innervation of the rabbit distal colon was studied by the use of the horseradish peroxidase (HRP) tracing technique. After injection of HRP, labelled cells were observed in sacral spinal cord segments S2-S5, primarily in the lateral intermediate grey matter. Labelled neurons were also observed in the lateral funiculus and sometimes in the ventral horn. No labelled cells were found in the vagal nuclei, contrary to the reports of earlier investigators. Anterograde transport of HRP resulted in labelling of visceral afferent neurons in dorsal root ganglia, whilst the central processes of afferent neurons entered Lissauer's tract and formed a collateral pathway along the lateral edge of the dorsal horn which terminated in close apposition to labelled preganglionic efferent neurons.

Animals↗
PubMed1996

[L5-S1 herniated disk migrated to the anterior part of the right sacral wing with compression of the right lumbosacral roots].

PURPOSE OF THE STUDY: The goal of this study was to report an exceptional case of far lateral and anterior disc herniation at L5-S1 level. CASE REPORT: A 47 year-old man presented a right L5 radicular pain with motor deficit of tibialis anterior and extensor hallucis longus resisting to medical management. Standard X-rays showed a degenerative process of L5-S1 disc. The CT scan was at first considered as normal. The myelogram was normal. A second study of the CT scan showed an opacity next to the L5 right root in front of the sacral wing. A discography combined with CT scan was then performed showing the migrated herniated disc from L5-S1 to the anterior part of the right sacral wing in contact with L5 root. RESULTS: Surgery was performed by transperitoneal approach and needed a difficult dissection of hypogastric vessels. The herniated disc was found behind the L5 root. A L5-S1 disc excision and arthrodesis with iliac grafts were performed. The result has been very good with relief of the pain and recovery of the palsy within a month. CONCLUSION: The lecture of a CT scan should include the far extraforaminal zone if there is no compression in the spinal canal. Such an anterior migration of an herniated disc has not been already described as far as we know.

Diskectomy↗
PubMed2004

Differential expression of calcium channels in sympathetic and parasympathetic preganglionic inputs to neurons in paracervical ganglia of guinea-pigs.

Neurons in pelvic ganglia receive nicotinic excitatory post-synaptic potentials (EPSPs) from sacral preganglionic neurons via the pelvic nerve, lumbar preganglionic neurons via the hypogastric nerve or both. We tested the effect of a range of calcium channel antagonists on EPSPs evoked in paracervical ganglia of female guinea-pigs after pelvic or hypogastric nerve stimulation. omega-Conotoxin GVIA (CTX GVIA, 100 nM) or the novel N-type calcium channel antagonist, CTX CVID (100 nM) reduced the amplitude of EPSPs evoked after pelvic nerve stimulation by 50-75% but had no effect on EPSPs evoked by hypogastric nerve stimulation. Combined addition of CTX GVIA and CTX CVID was no more effective than either antagonist alone. EPSPs evoked by stimulating either nerve trunk were not inhibited by the P/Q calcium channel antagonist, omega-agatoxin IVA (100 nM), nor the L-type calcium channel antagonist, nifedipine (30 microM). SNX 482 (300 nM), an antagonist at some R-type calcium channels, inhibited EPSPs after hypogastric nerve stimulation by 20% but had little effect on EPSPs after pelvic nerve stimulation. Amiloride (100 microM) inhibited EPSPs after stimulation of either trunk by 40%, while nickel (100 microM) was ineffective. CTX GVIA or CTX CVID (100 nM) also slowed the rate of action potential repolarization and reduced afterhyperpolarization amplitude in paracervical neurons. Thus, release of transmitter from the terminals of sacral preganglionic neurons is largely dependent on calcium influx through N-type calcium channels, although an unknown calcium channel which is resistant to selective antagonists also contributes to release. Release of transmitter from lumbar preganglionic neurons does not require calcium entry through either conventional N-type calcium channels or the variant CTX CVID-sensitive N-type calcium channel and seems to be mediated largely by a novel calcium channel.

Action Potentials↗
PubMedDate not supplied

Bilateral sacral radiculopathy in a cyclist.

UNLABELLED: OBJECTIVE-PURPOSE: The purpose of this case report is to describe a gait disorder presenting as a bilateral sacral radiculopathy after vigorous cycling. Also, we discuss the pathogenic mechanisms and we revise the bibliography. PATIENT AND METHODS: The patient complained of a rapid painless weakness in legs, after intense and prolonged cycling 4 months ago. The physical and electromyographical examinations revealed important weakness in foot and knee flexors, and signs of acute denervation with mixed reinnervation (active and chronic) in myotomal S1 muscles, respectively. The lumbo-sacral magnetic resonance imaging were normal. The follow-up studies demonstrated gradually improvement in clinical and neurophysiological parameters. DISCUSSION: We established that our patient presented a subacute bilateral S1 radiculopathy and we confirmed the progressive clinical and neurophysiological improvement. The radiculopathy are infrequent in cyclists, and its common origin is the external compressive aggression. In our patient we speculate and discuss that this radicular lesion could present different pathogenic mechanisms: the elongation, the compression and the secondary vasanervorum ischemia. In our knowledge S1 radiculopathy related to compressive lesions in sportsmen has not been previously described.

Adult↗
PubMed2003

Sacral neuromodulation in patients with interstitial cystitis: a multicenter clinical trial.

Female patients with interstitial cystitis (IC) unresponsive to standard oral and intravesical therapy were enrolled at three clinical sites for percutaneous sacral nerve root stimulation (PNS) in a prospective, observational pilot study. Evaluation was in the form of a 3-day voiding diary completed both prior to and following the commencement of sacral nerve root stimulation. Symptoms were also assessed by the O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices (ICSI and ICPI). Baseline and test stimulation values for voiding diary parameters and O'Leary-Sant scores were compared to determine treatment efficacy. A total of 33 patients were enrolled. Statistically significant improvements were seen in frequency, pain, average voided volume and maximum voided volume. Significant improvements were also seen in ICSI and ICPI scores. Subacute PNS appears to be effective in reducing symptom severity and increasing voided volumes in patients with IC previously unresponsive to standard therapy.

Adult↗
PubMed1994

Evaluation of the motor and sensory components of the pudendal nerve.

Extensive neurophysiological investigations consisting of different techniques to evaluate the efferents and afferents of the pudendal nerve were carried out in 27 healthy subjects. These investigations included motor evoked potential recordings from the external anal sphincter in response to magnetic stimulation of the cortex and lumbosacral roots, measurement of sacral reflex latency to magnetic and electrical stimulation, and cortical sensory evoked potential recording after stimulation of the dorso-genital nerve and anal canal. Motor latencies after transcranial magnetic stimulation to the anal sphincter were 25.1 +/- 2.9 msec at rest and 20.9 +/- 2.0 msec with voluntary sphincter contraction (facilitation). Motor latency after lumbosacral root stimulation was 3.7 +/- 1.0 msec. Mean sacral reflex latency after magnetic stimulation was 43.8 +/- 11.2 msec and was significantly longer than after electrical stimulation (37.0 +/- 7.2 msec; P < 0.05). P1 latency of the sensory evoked potentials after dorso-genital nerve stimulation was 40 +/- 3 msec and was significantly shorter than after anal stimulation 46 +/- 3 msec (P < 0.01). Evoked potential recording allows us to study both upper and lower motor neuron components to the anal sphincter. The present study paves the way for the combined application of these tests in the evaluation of disorders of the pelvic floor.

Adult↗
PubMed2003

[Bladder dysfunction and surgery in the small pelvis. Therapeutic possibilities].

The more extensive a surgical procedure in a small pelvis, the higher the risk for the lower urinary tract with its nerve supply and nerve plexus. This concerns mainly the sympathetic chains, the parasympathetic structures and, rarely, the visceral supply of the pelvic floor. Direct trauma to the bladder and its vascular supply as well as indirect injury by displacement of the bladder need to be seriously considered. Problems with micturition and impaired storage capacity of the bladder are the result. Complete urodynamic examination and follow-up can help in differentiating between temporary and persisting disturbances and in taking therapeutical decisions. The most evident postoperative complication is disturbed micturition, managed initially by suprapubic urinary diversion, followed as soon as possible by intermittent self-catheterisation. This is the only way to avoid overstretching of the bladder, recurring urinary tract infection and damage to the upper urinary tract. Restoration of spontaneous micturition can be supported by drug treatment with parasympatholytics and/or alpha-blockers if the measured bladder pressure and residual urine are within tolerable limits. For electrostimulation of micturition, intravesical therapy, although timeconsuming, is best suited because it can easily be done on an outpatient basis. More promising seems bilateral sacral neuromodulation, which, however, is a rather complicated and expensive procedure. Surgical procedures to reduce the voiding resistance of the bladder involve the risk of postoperative incontinence because the sphincter function in those patients is often disturbed too. Persisting problems with bladder storage capacity as a result of tumor surgery in the small pelvis are frequently secondary to retention of urine (overflow incontinence). In these cases, regular evacuation of the bladder by intermittent self-catheterisation can lead to social acceptance. Reduced bladder compliance and lowering of the urethral leak pressure point may result in stress and urge incontinence, which, according to the established rules, should be managed by physiotherapy and behaviour therapy as well as drug therapy and only in exceptional cases by surgical measures. Prevention of postoperative bladder dysfunction can be tried by tissue- and nerve-sparing surgical techniques, but is always determined by oncological aspects.

Diagnosis, Differential↗
PubMed2007

Resolution of symptoms of chronic constipation in an 8-year-old male after chiropractic treatment.

OBJECTIVE: This case report describes the history, treatment, and proposed explanation of a positive outcome in a patient with chronic constipation. CLINICAL FEATURES: An 8-year-old boy presented with chronic constipation. His mother reported that this had been a problem since the child's birth. Allopathic treatment consisting of laxatives, high fluid intake, and high fiber intake had not been effective to date. INTERVENTION AND OUTCOME: The patient was examined and it was determined that he had a sacral chiropractic subluxation complex. Manipulation of the sacral area using diversified adjusting procedures was performed. External massage of the abdomen starting in the right lower quadrant and following the course of the large intestine in a clockwise direction was also applied. The patient reported an immediate dramatic improvement in bowel function after the first treatment. Treatment was continued for a 4-week period (2 visits per week) and then discontinued when the patient (confirmed by his mother) reported consistent normal bowel function. A follow-up call made 13 years after treatment revealed continuing normal bowel function. CONCLUSION: This case suggests that chiropractic care may be helpful in some cases of chronic constipation.

Child↗
PubMed1976

The real bladder electromyogram.

The nature of bladder electrical activity was investigated in anaesthetised cats and 1 baboon. A time-locked muscle response to sacral ventral root stimulation was most clearly detected within a 10-40 Hz frequency band, the response preceding the rise in intravesical pressure. During reflex voiding only activity in the 10-40 Hz band was consistently related to reflex voiding and to the small contractions leading up to voiding. It is concluded that only a very limited part of the wide band electrical activity recorded from the bladder can be considered genuine electromyogram and that the 10-40 Hz frequency band probably excludes the worst of the artefact. Possible sources of artefact and their relation to changes in intravesical pressure are presented in Table I.

Animals↗
PubMed2002

Influences of pelvic floor structures and sacral innervation on the response to distension of the cat rectum.

The contributions to the rectal response to distension of the pelvic floor structures surrounding the rectum and of the sacral spinal innervation have never been studied. Using paralysed intercollicularly decerebrate, anaesthesia-free cats, we studied pressure-volume relationships during slow ramp distensions of the rectum. Results obtained from animals with intact pelvic cavities were compared with those following mobilization of the rectum from the pelvic floor musculature. To assess the influences of spinal outflow and afferent input, rectal pressure-volume relationships were measured in the mobilized rectum following bilateral sequential transection of the spinal roots S1 to S3, first dorsal, then ventral. Isolation of the rectum from the pelvic floor structures resulted in a decrease in balloon volume in the lower range of distension pressure but did not affect volumes at higher pressures. The only afferent effect was seen after sectioning of dorsal roots S1, which resulted in a decrease in balloon volume. The only efferent effect was seen after sectioning of ventral roots S3, which decreased balloon volume further. In conclusion, the rectal response to distension depends on the properties of the rectal wall. It may be influenced by somatic inputs, inputs from the myenteric nervous plexus, and from the parasympathetic and sympathetic nervous systems. Afferent inputs and spinal autonomic reflexes may decrease the tone of the rectal musculature during distension.

Animals↗
PubMed1999

Neuromodulation by implant for treating lower urinary tract symptoms and dysfunction.

OBJECTIVE: Patients with irritative micturition complaints, pelvic pain, involuntary urine loss or urinary retention are sometimes difficult to treat. The advent of direct sacral nerve stimulation offers a therapeutic alternative if conservative measures fail and surgery is considered. This paper reviews therapeutic neuromodulation by implant for treating lower urinary tract symptoms and dysfunction. METHODS: The international literature is reviewed on topics such as the physiological basis of neuromodulation, techniques of acute testing and chronic implantation, and clinical results. Future developments and ways for possible improvement are discussed. RESULTS: The mode of action of neuromodulation is probably through restoring the correct balance between excitatory and inhibitory impulses from and to the pelvic organs at a sacral and supra-sacral level. Depending on the predefined success criteria, average success rates of definitive implants vary from 50 to 70%. From the data it seems that patients with urge incontinence and urinary retention are the best candidates for neuromodulation. In the literature the lack of standardisation of selection criteria, stimulation parameters and definitions of success is striking. CONCLUSIONS: Neuromodulation by implant is a useful therapeutic alternative. It should at least be considered in patients with therapy-resistant urge incontinence and urinary retention before proceeding to surgery. Issues such as underlying physiology, methodological standardisation, technical improvements, and patient selection must be addressed in future research.

Animals↗
PubMed2005

Sacral-neuromodulation CT-guided.

PURPOSE: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four to ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. MATERIALS AND METHODS: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patients showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anomalies of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spinal needle introduced checking correct positioning with a CT control scan. An electrode was then inserted after having checked correct muscular contractile response and the precise position with a further CT scan. RESULTS: Thirty patients were subjected to PNE under CT guidance for a total of 38 centerings. Eight patients underwent the PNE procedure on both the S3 foramina. The sacral foramen was centred at the first attempt in 36 out of 38 cases. Two cases required several attempts to centre correctly the foramen. In 4 patients out of 30 a second electrode was implanted. In one patient who had a nonconsolidated sacral fracture, CT guidance enabled insertion of the electrode inside the only practicable foramen, a manoeuvre that would have been impossible with fluoroscopical guidance. Only once was the electrode placed in a wrong location but promptly repositioned after a CT control. During the whole trial period we had a positive response to the PNE test in 18 out of 30 patients (60%), a partial response in 4 out of 30 patients and a negative response in the remaining 8 patients. None of the patients who underwent the PNE test had infectious complications and the procedure was well tolerated by all. The procedure lasted about 45 minutes.

Adult↗
PubMed1994

Transcutaneous electrical localization and reversible blockade of the sacral nerve in the diagnosis of the urge syndrome.

To date, conventional urodynamic evaluation is not able alone to distinguish motor urgency with uninhibited detrusor contraction from sensory urgency. Transcutaneous electrical localization and reversible monolateral blockade of the 3rd sacral root was performed in 3 women with interstitial cystitis and in 2 men with idiopathic detrusor hyperreflexia by intranerve injection of 6 ml 0.5% Bupivacaine solution. The paralysis of the detrusor was completely reserved in all patients within 6 hours of the blockade. Cystometry and cystography were performed at 10 min, 2 and 6 hour intervals after the injection. In patients with the urge syndrome resulting from interstitial cystitis, there was a small increase in bladder capacity during the blockade. In contrast, the bladder capacity increased considerably during blockade in patients with idiopathic detrusor hyperreflexia. These results allowed us to differentiate the forms of the syndrome described above.

Diagnosis, Differential↗
PubMed1997

Acute suppression of idiopathic detrusor instability with magnetic stimulation of the sacral nerve roots.

OBJECTIVE: To assess the effect of magnetic stimulation of the S3 nerve root on unstable contractions in patients with idiopathic detrusor instability. PATIENTS AND METHODS: Twelve patients with idiopathic instability were studied. The S3 nerve root was localized by mapping the response of the toe flexor muscles and anal sphincter to magnetic stimulation at different sites. Unstable contractions were provoked by rapidly infusing saline into the bladder and the effect of magnetic stimulation of S3 on contractions was assessed. RESULTS: Magnetic stimulation relieved the sensation of urinary urgency and reduced the duration and amplitude of provoked contractions in all patients. Stimulation reduced the area under the pressure/time curve by 80-98%. In some patients there was a shortlived residual suppressive effect lasting up to 90 s. CONCLUSIONS: Magnetic stimulation of S3 acutely abolishes unstable contractions in patients with idiopathic detrusor instability.

Electromyography↗