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Gynaecology: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Complications of sacral nerve stimulation include failure and the need to reoperate (1). Complications of botulinum toxin A include failure and the need to self-catheterize; also, injections have to be repeated every nine months to one year (2). Complications of augmentation cystoplasty include bowel disturbance, metabolic acidosis, the need to self-catheterize, mucus retention and malignant change (2). Complications of urinary diversion include bowel disturbance and stoma herniation and retraction (1).
Gynaecological Considerations and Urogenital Fistulas
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Brooke Gurland, André D’Hoore, Paul Hilton
Sacral nerve neuromodulation (SNM) involves stimulation of the sacral nerve roots to modulate the reflexes that influence the bladder, colon, sphincter and pelvic floor. SNM uses mild electrical pulses to improve or restore normal voiding function. In the United States, InterStim Therapy received FDA approval for urge incontinence in 1997, for urgency frequency and urinary retention in 1999 and for chronic faecal incontinence in 2011. Sacral nerve stimulation can be used to treat both overactive bladder and chronic faecal incontinence.13,14
The anus and anal canal
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Again, as a result of prior use in urinary incontinence, sacral nerve stimulation has been used to treat faecal incontinence, with encouraging short- and medium-term results. Rather than any direct action on sphincter strength, this technique appears to work by sensorimotor neurophysiological modulation of the hindgut through electrical stimulation of the sacral nerve roots via a needle positioned through one of the posterior sacral foramina (Figure 74.23). The advantage of this technique is its relatively non-invasive nature, causes no additional damage to the sphincter, as well as the fact that its effects can be tested by temporary stimulation using an external stimulator before the expensive permanent pacemaker is implanted. A much cheaper and less invasive novel technique to treat faecal incontinence, again mediated through neuromodulation, is percutaneous posterior tibial nerve stimulation (PTNS). Results from a prospective comparative study suggest that there is no benefit in faecal incontinence over placebo effect.
Effectiveness and safety of sacral neuromodulation for neurogenic bladder
Published in Neurological Research, 2023
ZengGang Wei, Yong Zhang, JianPing Hou
The system evaluation is carried out according to the statement of preferred report items [11] of system evaluation and meta-analysis. After formulating the review plan, we systematically search(Pubmed), Cochrane Library and other databases, and collect clinical researches and treatises on neurogenic bladder and sacral neuromodulation therapy combined with the method of literature retrospective. No language or date restrictions apply. Search term(sacral nerve stimulation OR sacral neuromodulation) AND (incontinence OR lower urinary tract dysfunction OR neurogenic bladder OR urinary retention OR lower urinary tract symptoms) AND (neurogenic OR multiple sclerosis OR spinal cord injury OR spina bifida OR myelomeningocele OR cerebral vascular disease OR Parkinson’s disease OR Alzheimer’s disease OR diabetic peripheral neuropathy OR detrusor hyperreflexia OR detrusor overactivity OR detrusor sphincter dyssynergia)
Are video-urodynamics superior to traditional urodynamic studies in changing treatment decision with urinary symptoms?
Published in Arab Journal of Urology, 2019
Sana H. Ansari, Ayman E. Mahdy
The treatments were categorised as such: No intervention or stop current therapy.Oral medication (β3-adrenoceptor agonists, anticholinergics, muscle relaxants, α antagonist, or combination).Minimally invasive (sacral nerve stimulation, chemical denervation of bladder, mid-urethral sling, urethral bulking, urethral dilatation).Major surgery (continent or incontinent diversion with or without anti-incontinence procedure or cystectomy, bladder augmentation).Conservative (pelvic floor physical therapy; fluid and diet management, timed voids; pessary; indwelling catheter, clean intermittent catheterisation, suprapubic tube).
Current development and clinical applications of artificial anal sphincter
Published in Expert Review of Medical Devices, 2023
Minghui Wang, Yunlong Liu, Qingjun Nong, Hongliu Yu
Over the past 20 years, numerous developments have been made in the surgical therapies available to treat FI. The traditional surgical approach is sphincteroplasty, which is limited to a small group of patients with isolated defect of the external sphincter. Sacral nerve stimulation and artificial anal sphincter are innovative surgical therapies, which should be restricted to highly selected patients [16–18]. Colostomy is effective and well-accepted surgical therapy to treat FI, if other therapies fail or the patient is not suitable for the previously described conservative or surgical therapies [19–21].