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Neural engineering
Published in Alex Mihailidis, Roger Smith, Rehabilitation Engineering, 2023
As an alternative to all of these therapies, electrical stimulation of the saphenous nerve (SAFN) is being investigated as a means of modulating bladder function. The SAFN is a purely sensory nerve that branches off the femoral nerve trunk. It innervates the medial skin surface of the lower leg and projects proximally to the lumbar spinal cord (L2–L3 in humans). The projection of the SAFN to the lumbar nerve roots is notably different from that of the pudendal nerve and the tibial nerve. And while the precise mechanism is not yet known, it is hypothesized that the SAFN electrically activates a different bladder-inhibitory reflex than those evoked by pudendal, sacral, and tibial nerve stimulation. Evidence of an inhibitory SAFN-to-bladder reflex has been shown in urethane anesthetized rats (Moazzam and Yoo 2018), where low-amplitude electrical pulses applied between 10 Hz and 20 Hz resulted in significant increases in bladder capacity and also the interval between successive bladder contractions. The effects of SAFN stimulation were also demonstrated in a pilot clinical study involving OAB patients (Macdiarmid, John, and Yoo 2018). This recently published study showed that 87.5% of patients responded positively to percutaneous SAFN stimulation, which was applied weekly for 12 weeks. Patients showed significant improvements in every quality-of-life measure (OAB-q survey) and showed particularly notable reductions in nighttime symptoms (nocturia and urge incontinence). This novel therapeutic approach is being further clinically validated and commercialized.
Minimally invasive surgery of the hip joint
Published in K. Mohan Iyer, Hip Joint in Adults: Advances and Developments, 2018
Matthew K. T. Seah, Wasim Khan
According to current data, the overall risk of an adverse event following hip arthroscopy is 4%-7% [49]. Serious complications, such as infection, thromboembolism, neurovascular damage and hip fracture or dislocation, are rare (<1%) [50]. However, a small number of complications specific to hip arthroscopy have been reported, including abdominal compartment syndrome, perineal and genital trauma, pudendal nerve neuralgia and superficial nerve damage. The overall reoperation rate is 6% and occurs on average 16 months after the primary procedure [51].
An update on research and outcomes in surgical management of vaginal mesh complications
Published in Expert Review of Medical Devices, 2019
Dominic Lee, Philippe E. Zimmern
For intractable pain following surgical excision, a multimodal therapy regime is often required, and most often conducted by the department of Physical medicine and rehabilitation. It includes optimal medical pain management, pelvic floor muscle physiotherapy and regional nerve blocks for patients (such as pudendal nerve blocks) with neuropathic type pain. Gyang et al. has provided a nice review and a management algorithm for mesh-related CPP [54].