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PubMed1998

[Video-taped utero-sacral ablation, an alternative treatment of primary incapacitating dysmenorrhea].

Incapacitating dysmenorrhea has been treated in many different ways both medical and surgical. The best result yet is by uterosacral ablation. The purpose of this study is to demonstrate the utility of uterosacral ablation as treatment for incapacitating dysmenorrhea. This is a prospective longitudinal study of a cohort in which patients were their own controls. The no probabilistic sample of work was of 15 patients in the service of Gynecology being studied for incapacitating primary dysmenorrhea, under treatment for at least three months without favorable response. Videolaparoscopy was performed using CO2 as distention gas. A 10 mm lens grand angular Storz Karl and monopolar feeding was used for the ablation. Follow up was for six to sixteen months, grading the response to treatment in absent, mild, moderated and good. Considering a good response was when pain allowed daily activity. X2 was used at a level of significance of 0.05. In relationship with pain one (7%) was asintomatic, nine (50%) were mild, three (20%) moderate, two (13%) remained with no changes. Comparing the difference pre and post treatment had, statistical significance on a P 0.0025 was in favor of the improvement. We conclude in spite of the smallness of the sample, results are encouraging because any degree of improvement is of benefit to the patient for her quality of life.

Adolescent↗
PubMed2000

Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention.

Many patients have chronic, debilitating symptoms of voiding dysfunction that are refractory to conventional medical or surgical therapies. This multicenter, prospective study evaluated the long-term effectiveness of sacral nerve stimulation using the implantable Medtronic InterStim therapy for urinary control in patients with otherwise intractable complaints of urinary urge incontinence, urgency-frequency, or retention. Each patient first underwent temporary, percutaneous sacral nerve test stimulation. If at least a 50% reduction in target symptoms was documented for at least 3 days, patients received a permanent Medtronic InterStim sacral nerve stimulation system that includes a surgically implanted lead and neurostimulator. Regular follow-up was conducted with outcome data. We report here on patients who have been observed from 1.5 to 3 years postimplantation. The results demonstrate that after 3 years, 59% of 41 urinary urge incontinent patients showed greater than 50% reduction in leaking episodes per day with 46% of patients being completely dry. After 2 years, 56% of the urgency-frequency patients showed greater than 50% reduction in voids per day. After 1. 5 years, 70% of 42 retention patients showed greater than 50% reduction in catheter volume per catheterization. We conclude that the Medtronic InterStim therapy for urinary control system is an effective therapy with sustained clinical benefit for patients with intractable symptoms of urinary urge incontinence, urgency-frequency, or retention.

Adolescent↗
PubMed2006

Complications and troubleshooting of two-stage sacral neuromodulation therapy: a single-institution experience.

OBJECTIVES: With the increasing use of sacral neuromodulation therapy, urologists are faced with postimplantation challenges. The purpose of this study was to identify these events and their causes and management in our large single-institution experience. METHODS: From July 2002 to September 2004, all patients who underwent sacral neuromodulation therapy for refractory bladder conditions were identified. Their medical records were retrospectively evaluated for history, operative intervention, and programming visits. Events after implantation of the implantable pulse generator (IPG) unit were noted. The evaluation, troubleshooting, management, and resolution of events at the last follow-up visit were extracted. RESULTS: A total of 214 patients underwent sacral neuromodulation therapy at our institution. The mean patient age was 53.5 +/- 15.4 years. Of the 214 patients, 161 underwent IPG implantation during a mean follow-up period of 16 months (range 5 to 30). The second-stage explantation and revision rate was 10.5% and 16.1%, respectively. The indications for explantation were infection (8 of 17) and failure to maintain a response (9 of 17). Revisions were done for decreases in response with abnormal (12 of 26) or normal (5 of 26) impedance measurements, IPG site discomfort (4 of 26), draining sinus at the IPG site (4 of 26), and lead migration (1 of 26). Equalization of impedance measurements was the most commonly observed impedance abnormality. These were managed by drying fluid from the connection in 4 patients and lead change in the rest. CONCLUSIONS: After IPG implantation, a decline in response may occur. Although some were explanted, most were revised, with most of the revisions functional on follow-up. Familiarity with impedance evaluation and development of algorithms for postimplant management are essential for troubleshooting and maintenance of the device.

Electric Stimulation Therapy↗
PubMed2006

Ultrasound imaging of sacral reflexes.

OBJECTIVES: To investigate the reliability of examination of the guarding reflex of the pelvic floor by dynamic perineal ultrasonography in children with bladder dysfunction and in controls. METHODS: A total of 40 patients with nonneurogenic bladder/sphincter dyssynergia, 40 with spina bifida, and 40 controls underwent a dynamic ultrasound examination of the pelvic floor while coughing and while being tapped on the abdominal wall. The reflex action of the puborectal muscle in females, and the combined action of the puborectal muscle and external sphincter muscle in males, were recorded. RESULTS: Of the 40 patients with nonneurogenic bladder/sphincter dyssynergia, 38 had a normal reflex action of the puborectal muscle during the abdominal tap and 36 had a normal reflex action when coughing. Two of these patients had unexplained underactive bladder syndrome and were using clean intermittent catheterization, and two could not be assessed because of hypermobility of the bladder neck when coughing but had a normal reaction during abdominal tapping. Of the 40 patients with spina bifida, none had puborectal activity during coughing and 5 had some puborectal activity during tapping. Of the 40 controls, 39 had normal reflex activity during both coughing and tapping. CONCLUSIONS: The question of whether a child has nonneurogenic or neuropathic bladder/sphincter dysfunction is often difficult to answer on the basis of urodynamic studies alone. Dynamic perineal ultrasound recording of the S2-S4 reflex arches provides reliable additional information and is noninvasive to the patient.

Child, Preschool↗
PubMed2001

Computerized assessment of detrusor instability in patients treated with sacral neuromodulation.

PURPOSE: We previously described an automatic procedure for diagnosing and grading detrusor instability using a cystometric study. In our current study we applied a modified version of the program in patients with urge incontinence treated with sacral neuromodulation to test its capacity to detect changes after therapeutic intervention and understand the mode of action of neuromodulation. MATERIALS AND METHODS: We analyzed cystometric studies before and after neuromodulation in 26 consecutive patients, including 22 women and 4 men, and evaluated parameter changes. We also assessed the relationship of instability parameters at baseline with symptomatic results, which were derived from voiding-incontinence diaries, in female patients to identify urodynamic prognosticators of success. RESULTS: The automatic procedure correctly diagnosed stability and instability in our patients in 51 of the 52 measurements considered. Neuromodulation had an average suppressive effect on the amplitude of unstable contractions. At baseline the amplitude of the maximum unstable contraction and mean active pressure during unstable episodes were significantly less in the 7 women who achieved stability than in the 15 who did not. However, no urodynamic parameters were identified that predicted the symptomatic outcome of treatment. CONCLUSIONS: Our algorithm accurately diagnoses and grades detrusor instability, and provides parameters with predictive value in regard to the probability that a bladder may or may not become stable with neuromodulation. However, the symptomatic result of this treatment option seems to depend on noncystometric factors.

Algorithms↗
PubMed2000

[Interaction between pelvic and pudendal afferent inputs in lumbar-sacral spinal cord in rats].

Time-dependent inhibition is one of the means to study the interactions between peripheral inputs. The present study was performed on anesthetized and paralyzed Wistar rats using the technique of conditioning-testing stimulation. Electric stimulation (1.5 3 folds of the threshold intensity) was given to pelvic and pudendal nerves. Extracellular recordings were made from convergent neurons at L(6)-S(1) segments of the spinal dorsal horn. Stimulus intervals between conditioning and testing stimulation were measured when a half of the testing responses were inhibited by conditioning responses or the inhibition just began to occur. The time-dependent inhibition was seen in neurons situated deeper than 300 m beneath the dorsal surface of the spinal cord, and not in more superficial neurons. The inhibition intervals were in the range of 1 360 ms and became longer when conditioning stimulation was given to the pelvic nerve. The inhibition intervals were 1 3 ms in superficial neurons (<300 micrometer) and no apparent time-dependent inhibition occurred. The inhibition in deeper neurons was partially reduced by cold block conducted at segments C(5-6) and the blockage was more significant when conditioning stimulation was applied to the pelvic nerve. These findings suggest that the inputs from the pelvic and pudendal nerves may converge on single neurons at deeper lumbosacral dorsal horn and the pudendal nerve induced responses are more likely to be inhibited in these neurons, which may be further strengthened by superspinal structures.

Afferent Pathways↗
PubMed1998

[Hoffmann reflex elicited by magnetic stimulation of S1 nerve roots in the diagnosis of diabetic radiculopathy].

OBJECTIVE: To determine the incidence of radiculopathy in diabetic patients neurophysiologically. METHODS: The H-reflexes were elicited by magnetic stimulation to S1 nerve root at the first sacral foramen (S1 H-reflex) in 40 normal subjects and 41 diabetic patients. The action potentials of the H-reflex were recorded from the soleus muscle. For comparison, a popliteal H-reflex (stimulated at popliteal fossa), and a regular distal sensory and motor conduction of the tibial nerves were simultaneously evaluated. RESULTS: A significant correlation of the peak interval of H wave and M wave (HMI) of the S1 H-reflex with body height and age was confirmed by multiple regression analysis in the normal subjects. The simultaneous regression of the HMI adjusted on age and body height produced the formula as 0.02 x (age) + 0.03 x (height) + 0.92. At 95% normal limits of the significant test, 40.2% HMI and 53.7% amplitude of H waves of the S1 H-reflex, 54.9% latency and 46.3% amplitude of H waves of the popliteal H-reflex, 40.2% SCV and 40.2% amplitude of sensory action potentials were diagnosed as abnormal. CONCLUSIONS: A high incidence rate of diabetic radiculopathy was confirmed to be comparable to that of proximal neuropathy and distal symmetrical sensory polyneuropathy. This suggests that diabetic neuropathy may be related to metabolic and/or vascular disorders.

Adult↗
PubMed1997

Modulation of feline bladder and distal urethral responses to dorsal sacral root stimulation by intrathecal administration of a kappa 1-opioid agonist.

OBJECTIVES: We examined bladder and distal urethral responses to sacral dorsal root (SDR) electrostimulation with simultaneous intrathecal administration of a kappa 1-opiate agonist. METHODS: Experiments were conducted on 14 spinally intact and 6 chronic spinally transected decerebrated mongrel cats. In the chronically spinalized cats, midthoracic complete spinal cord transection was performed 6 to 8 weeks before the electrostimulation experiments. Sympathetic denervation was carried out by cutting the sympathetic chain and the hypogastric nerve bilaterally. Proximal ends of the cut S1-3DR were stimulated, and bladder pressure and urethral perfusion pressure changes were recorded before and after drug administration. RESULTS: The S2DR electrostimulation in spinally intact cats produced the best vesical contraction, but with dyssynergic urethral response. The magnitude and the pattern of the response changed with the different stimulation parameters. U-50,488H, a selective kappa 1-opiate receptor agonist, decreased significantly the bladder and the urethral responses to S2DR stimulation in spinally intact but not in chronic spinally transected cats. Nor-BNI, a kappa antagonist, reversed these responses in spinally intact cats. CONCLUSIONS: Our results showed that it is feasible to produce bladder contraction with SDR stimulation and suggest that kappa 1 receptors may have a role in bladder and distal urethral reflexes at the suprasacral level.

Animals↗
PubMed1991

Anatomic consideration for sacral screw placement.

Instrumentation of the lumbosacral spine increasingly involves screw fixation to the sacrum. Recommended locations and techniques for screw placement vary, particularly when bicortical purchase of the sacrum is performed. The purpose of this study was to describe the critical anatomy and potential injuries to neurovascular and visceral structures anterior to the sacrum. Lack of awareness can lead to life-threatening complications. The study included 22 fresh human cadavers with no prior spinal surgery. Specimens were placed in a prone position, and the lumbosacral spine was exposed. Two 6.5-mm screws were inserted using one of two techniques, respectively: Starting just inferior to the S1 facet one screw was angled 25 degrees caudally and 30 degrees laterally; in the second technique, lateral inclination was increased to 45 degrees. In addition, all specimens had screws placed in the S2 pedicles. An anterior dissection was performed to allow evaluation of the neurovascular and visceral structures at risk for injury by, or adjacent to, the screw tips. All significant neurovascular structures in the area of concern were constant in position. The internal iliac vein and the lumbosacral nerve trunk were most at risk for injury by the 30 and 45 degrees laterally directed screws. The sigmoid colon, though close to the S2 screw, was protected by its mesentery. Screws placed in the S1 pedicle were least likely to injure the neurovascular bundle. A lateral and a midline safe zone were identified.

Aged↗
PubMed2002

Control of leg-powered paraplegic cycling using stimulation of the lumbo-sacral anterior spinal nerve roots.

We investigated leg-powered cycling in a recumbent tricycle for a paraplegic using functional electrical stimulation (FES) with the lumbo-sacral anterior root stimulator implant (LARSI). A female complete T9 paraplegic had a stimulator for the anterior L2 to S2 spinal roots (bilaterally) implanted in 1994. She was provided with equipment for daily FES cycling exercise at home. The cycling controller applies a pattern of stimulation in each of 16 crank angle phases. A 7-bit shaft encoder measures the crank angle with adequate precision. Each pattern was originally chosen to give the greatest propulsive force in that position when there was no motion. However, dynamically, some reduction in co-contraction is needed; also the patterns are applied with a preset advance time. Maximal power is obtained with an advance of 250 ms, which compensates for muscle response delay and accommodates changes in cadence (from about 25 to 85 rpm). With this system, she has cycled 1.2 km at a time on gently undulating road. We found that spinal root stimulation gives sufficient control over the muscles in the legs to produce a fluid cycling gait. We propose that root stimulation for leg cycling exercise may be a practicable and valuable function for paraplegics following spinal cord injury.

Adult↗
PubMed1975

Abnormalities in Schwann cell sheaths in spinal nerve roots of dystrophic mice.

Dorsal and ventral spinal roots at cervical, thoracic, lumbar and sacral levels in dystrophic, dy/dy, mice of both 129/ReJ and C57Bl/6J phenotypes showed a complete lack of Schwann cell sheaths of any sort around the majority of their nerve fibres. This condition, termed amyelination, is more extensive (up to 1-5 cm in length) in the longer lumbar and sacral roots than in the shorter roots or in the proximal regions of the sciatic nerve which are also affected to some extent. Amyelination does not appear to be a consequence of myelin or Schwann cell degeneration, as debris is uncommon. Heterozygous carriers are not affected in any obvious way. Myelinated fibres, with Schwann cells of peripheral origin, occur immediately adjacent to the spinal cord in both dorsal and ventral roots, while in dorsal roots unmyelinated fibres also occur, as in normal animals. Amyelinated fibres begin to appear a few internodal lengths away from the cord and are present until near, or within, the dorsal root ganglion, where they become myelinated again. The portion of an axon which has no myelin begins at a normal appearing paranodal region (termed a half node of Ranvier) at the end of a myelin internode. Resumption of myelination likewise begins at a half node. A few myelinated axons may be seen in any given cross section of a root, but as a rule a given myelinated fibre does not remain myelinated throughout the whole length of the root. It is suggested that the nerve lesions develop where the nerves are lengthening rapidly as the animal grows and changes its shape. How these nerve changes release to those in muscle is conjectural.

Animals↗
PubMed1980

Response patterns of human lumbo-sacral motoneurone pools to distant somatosensory stimuli.

The response of human lumbo-sacral motoneurones to electrical stimuli applied to the trunk, the face and the arms was evaluated by means of H reflex testing in extensors and averaging the rectified tonic EMG recorded from extensors as well as flexors. In extensor and flexor muscles, the reflex pattern consisted of a non-reciprocal inhibition-facilitation, occurring with latencies of about 60 and 80 msec, respectively. With reflex testing, only facilitation was observed in extensors, beginning after a conditioning-test interval of about 40 msec and peaking at about 80 msec. This discrepancy was interpreted to indicate excitation supraliminal in a facilitatory and subliminal in an inhibitory pathway, the latter requiring an additional input to impinge on motoneurones. Afferents responsible for the described reflex actions were identified as belonging mainly to low-threshold skin nerve fibres, conducting with a maximum velocity of about 45--50 m/sec. However, medium threshold skin afferents as well as muscle and joint afferents may also play a role. Stimulation of C5 and T10 skin areas close to the neuraxis revealed similar effects, the latencies being shorter or equal with T10 compared with C5 stimulation. The possibility of a directly descending propriospinal pathway is discussed, mediating the inhibitory as well as the excitatory reflex actions described.

Adolescent↗
PubMed1999

Sacral nerve stimulation and diurnal urine volume.

OBJECTIVES: During a screening trial to determine candidacy for sacral nerve stimulation (SNS), several patients were required to repeat the baseline dietary because of discrepancies in the 24-hour urine output before and after successful stimulation. This raised a question regarding the relationship between urine production and neuromodulation. A more complete diary analysis of patients affected by urgency/frequency and/or urge incontinence was therefore carried out to evaluate the possibility of a direct modulatory influence of SNS on urine production. METHODS: Voiding diaries of 40 patients (37 females and 3 males, average age 39.4 years) who underwent SNS were evaluated. Voiding diaries were obtained at baseline, during and after peripheral nerve evaluation (PNE) and after permanent implantation. RESULTS: There was an increase in the average volume/void during PNE in 39 patients. Twenty-four-hour urine volume during PNE was statistically greater than that at baseline. Volume/void and diurnal volume were also significantly greater in follow-up periods after permanent implantation. CONCLUSION: SNS appears to influence not only bladder function but also urine production. Increase in volume/void is paralleled by an increase in 24-hour urine output. The mechanism is unclear, but it is consistent with an altered release of antidiuretic hormone. This observation reflects the direct refractory involvement of the hypothalamus in micturition.

Adolescent↗
PubMed2004

Systematic review of sacral nerve stimulation for faecal incontinence and constipation.

BACKGROUND AND METHOD: This systematic review assesses the efficacy and safety of sacral nerve stimulation (SNS) for faecal incontinence and constipation. Electronic databases and selected websites were searched for studies evaluating SNS in the treatment of faecal incontinence or constipation. Primary outcome measures included episodes of faecal incontinence per week (faecal incontinence studies) and number of evacuations per week (constipation studies). RESULTS: From 106 potentially relevant reports, six patient series and one crossover study of SNS for faecal incontinence, and four patient series and one crossover study of SNS for constipation, were included. After implantation, 41-75 per cent of patients achieved complete faecal continence and 75-100 per cent experienced improvement in episodes of incontinence. There were 19 adverse events among 149 patients. The small crossover study reported increased episodes of faecal incontinence when the implanted pulse generator was switched off. Case series of SNS for constipation reported an increased frequency of evacuation. There were four adverse events among the 20 patients with a permanent implant. The small crossover study reported a reduced number of evacuations when the pulse generator was switched off. CONCLUSION: SNS results in significant improvement in faecal incontinence in patients resistant to conservative treatment. Early data also suggest benefit in the treatment of constipation.

Constipation↗
PubMed2003

[Continuous bilateral sacral neuromodulation as a minimally invasive implantation technique in patients with functional bladder changes].

OBJECTIVE: Up to 50% of patients with bladder dysfunctions undergoing sacral neuromodulation treatment are non-responders. The most common treatment method today is the implantable neuromodulation system described by Tanagho and Schmidt; which allows unilateral sacral nerve stimulation. Our aim was to increase the number of responders and to improve the general efficiency of chronic sacral neuromodulation; therefore we have developed the bilateral electrode implantation by minimally invasive laminectomy. METHODS: PNE-tests were carried out to assess which patients were likely to be good responders. Thirty patients (16 with detrusor instability, 14 with hypocontractile detrusors) were subjected to minimally invasive laminectomy and received implants of bilateral electrodes. RESULTS: In those patients with a hyopcontractile detrusor, the level of residual urine of initially 350 ml was reduced to 58 ml, and the maximum detrusor pressure during micturition increased from initially 12 cMH2O to 34 cmH2O. In the other patient group with detrusor instability, the average number of incontinence incidences could be reduced from initially 7.2 to 1 per day, while the bladder capacity rose from 198 ml to 348 ml. The modulation effect did not show any signs of deteriorating in any of the patients. The follow-up period was 28 months on average. CONCLUSIONS: Clinical experience has shown that optimal neuromodulation in patients with bladder dysfunction can be achieved by this new approach involving bilateral electrode implantation. Moreover, the laminectomy implantation method guarantees a minimum of invasive trauma and enables optimal placement and fixation of the electrode.

Electric Stimulation Therapy↗
PubMed2006

L6-S1 spinal nerve stimulation reduces micturition frequency in anaesthetized rats with cyclophosphamide-induced cystitis.

OBJECTIVE: To further investigate the rationale for using spinal nerve stimulation (SNS) for treating bladder overactivity associated with cystitis in a rat model of cyclophosphamide-induced cystitis, as several studies suggested that symptoms associated with chronic cystitis could be treated using stimulation of sacral spinal nerves, but the mechanisms by which it works are unknown. MATERIALS AND METHODS: Cystitis was induced by i.p. injection of cyclophosphamide 48 h before the experiments in anaesthetized male rats. Neurograms were taken by placing a recording electrode onto the pelvic nerve and a stimulating electrode on either the L6 or S1 ipsilateral spinal nerves. Two selected intensities were then evaluated for SNS in control and cyclophosphamide-treated rats during cystometry. RESULTS: Cyclophosphamide resulted in significant bladder overactivity. There was no apparent difference in the neurograms generated in response to SNS of the S1 and L6 spinal nerves, and between cyclophosphamide and control rats. Intensities of 200 microA (Adelta-fibre-specific) and 2 mA (Adelta+ C-fibres) were chosen for SNS. Continuous SNS at 200 microA significantly reduced the frequency of voiding and non-voiding contractions in cyclophosphamide-treated rats. SNS at 2 mA resulted in the abolition of voiding contractions, accompanied by continuous leakage of urine. CONCLUSION: SNS recruiting only Adelta-fibre produced fewer voiding contractions in cyclophosphamide-treated rats, to a level similar to that from the control rats. These results support the ability of SNS to decrease bladder overactivity in a pathophysiological model of chemical irritation of the bladder.

Animals↗
PubMed2004

Remodelling of connections in pelvic ganglia after hypogastric nerve crush.

Pelvic ganglia innervate the urogenital organs and contain both sympathetic and parasympathetic neurons. Previous studies have shown that within days of cutting either the lumbar or sacral preganglionic axons that innervate pelvic ganglia, many axon collaterals grow and appear to form specific connections with denervated pelvic neurons. Here we have examined the longer term consequences of partial deafferentation by studying pelvic ganglia up to 7 weeks after hypogastric nerve (HGN) crush, a lesion which also allows faster regeneration of spinal axons. Noradrenergic neurons were denervated by HGN crush, as demonstrated by loss of varicosities immunostained for the synaptic proteins, synaptophysin and synapsin. A week after HGN crush, axon collaterals grew from parasympathetic pelvic ganglion neurons, shown by the presence of numerous varicose fibers immunostained for vasoactive intestinal peptide (VIP). These VIP fibers were poorly stained or unstained for synaptophysin, even after 7 weeks. At early post-operative times the VIP fibers grew irregularly; however, with longer post-operative times they appeared to target particular VIP-negative, noradrenergic neurons. Our results also indicate that some lumbar preganglionic axons regenerated during the post-operative period, although this only affected a minority of sympathetic neurons. These reinnervated sympathetic neurons were not associated with VIP fibers, suggesting that the new intrinsic connections may have precluded regeneration or targeting of preganglionic axons. Together these results demonstrate that there is considerable remodelling within pelvic ganglia after partial deafferentation. This occurs under conditions where spinal preganglionic axons can regenerate. New intra-ganglionic connectivity may be permanent and may impact on this regeneration.

Animals↗
PubMed2005

Effect of sacral neuromodulation on the rectum.

BACKGROUND: Sacral neuromodulation (SNM) is a new treatment for faecal incontinence. At present the exact underlying mechanism is still unclear. Modulation of the sacral reflex arcs might have an effect on rectal sensitivity, wall tension and compliance. METHODS: Fifteen consecutive patients with faecal incontinence who qualified for SNM underwent barostat measurements before and during neuromodulation. An 'infinitely' compliant plastic bag with a volume of 600 ml was placed in the rectum and connected to a computer-controlled barostat system. An isobaric phasic distension protocol was used. Patients were asked to report rectal filling sensations: first sensation (FS), earliest urge to defaecate (EUD) and an irresistible, painful urge to defaecate (maximum tolerated volume; MTV). Rectal wall tension and compliance were calculated. RESULTS: During isobaric phasic distension each patient experienced all rectal filling sensations at the time of stimulation. Median volume thresholds decreased significantly during stimulation, from 98.1 to 44.2 ml for FS (P = 0.003), from 132.3 to 82.8 ml for EUD (P = 0.001) and from 205.8 to 162.8 ml for MTV (P = 0.002). Pressure thresholds tended to be lower for all filling sensations, but only that to evoke MTV was reduced significantly by stimulation (37.3 versus 30.3 mmHg; P = 0.005). Median rectal wall tension for all filling sensations decreased significantly with stimulation. There was no significant difference between compliance before and during stimulation. CONCLUSION: SNM affects rectal sensory perception, but further research is required to clarify the mechanism.

Adult↗