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Faecal Incontinence
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
P. Ronan O’Connell, Thomas Dudding
Neuromodulation is a relatively new treatment modality for FI that is based on recruitment of residual anorectal neuromuscular function pertinent to continence by electrical stimulation of the peripheral nerve supply. Sacral nerve stimulation (SNS) employs direct electrical stimulation of the sacral nerve roots (mainly the S3 nerve root) and is a safe, effective treatment for FI (see below). The tibial nerve contains afferent and efferent fibres originating from the lumbar and sacral plexuses, including S3; thus, stimulation of the tibial nerve may lead to changes in anorectal neuromuscular function similar to those observed with SNS but without the need for a permanent, surgically implanted device. First described treatment for urinary incontinence, Shafik et al. proposed using percutaneous tibial nerve stimulation (PTNS) for faecal incontinence.86 Two methods of outpatient delivery of TNS have since been described: PTNS, in which a needle is placed near to the tibial nerve at the ankle, just above the medial malleolus, and transcutaneous electrical nerve stimulation (TENS), in which two surface electrodes are placed over the tibial nerve just above the medial malleolus ankle. The stimulation parameters are set to a pulse frequency of 10Hz and a pulse width of 200 µs, with a stimulation current of 0–30 mA.87 Whilst both techniques have shown benefits in continence outcome and quality of life assessment, there is a potentially large placebo effect.
Urinary incontinence
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Sacral nerve stimulation has been used to treat refractory lower urinary tract dysfunction in adults, but it has fallen into disrepute in children because of its invasive nature. However, there are other methods that are also invasive, for treating children with diurnal incontinence: by genital, anal, intravesical and percutaneous tibial nerve stimulation. Percutaneous tibial nerve stimulation in children is found to be minimally invasive and has shown an improvement in micturition symptoms, flow rates, PVR volumes, and incontinence.
The Spleen(SP)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: Women treated with percutaneous tibial nerve stimulation for overactive bladder syndrome may experience a transient sensory deficit in the region of SP 1, SP 2, to SP 3. Acupuncture along the SP line may aid in the recovery of sensory nerve function in the tibia.25 The fact that sacral spinal segments contribute significantly to the fiber composition of the tibial nerve helps explain why stimulation of points such as SP 6 and KI 3 neuromodulate pelvic organ function, and why these points appears so often in needling protocols for genitourinary concerns and voiding dysfunction. In particular, segments supplying the tibial nerve as it innervates the flexor hallucis longus and flexor digitorum longus arise from S2 and S3, the most caudal segments associated with the tibial nerve.
Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects
Published in Expert Review of Medical Devices, 2022
Sam Tilborghs, Stefan De Wachter
Advancements in research should thrive for restoration of lower urinary tract function and >90% ITT response as definitive endpoints. This could lead to an expansion of different conditions eligible for SNM and potentially even combined treatments. Efficacy rates vary between neuromodulation techniques, with the highest efficacy rates seen for SNM [207]. Currently it is unknown if a combination of (neuromodulation) treatments with different stimulation targets could cause a potential add-on effect. Other options are, for example, percutaneous tibial nerve stimulation (PTNS), however, overall improvements seem to remain modest [208]. While sacral neuromodulation excites a select few pudendal nerve fibers, direct neurostimulation of the pudendal nerve itself may also suppress voiding reflex. Marinkovic et al. stated that pudendal neuromodulation could serve as a welcome addition for failed SNM patients, demonstrating the need for pudendal neuromodulation to be prospectively studied [6].
Percutaneous tibial nerve stimulation for idiopathic and neurogenic overactive bladder dysfunction: a four-year follow-up single-centre experience
Published in Scandinavian Journal of Urology, 2021
K. Andersen, H. Kobberø, T. B. Pedersen, M. H. Poulsen
In the last 15 years, percutaneous tibial nerve stimulation (PTNS) has been shown to be a safe and effective treatment for OAB. PTNS has demonstrated efficacy in the treatment of idiopathic OAB in sham-controlled studies [6]. In women, the effect of PTNS is compatible with the effect of antimuscarinic treatment, but with a superior side-effect profile [3,7]. In men, there is insufficient evidence to conclude efficacy [3]. Patients with a neurological disease have shown a favourable response on the same parameters as idiopathic OAB patients, such as a reduction in daytime frequency, nocturia, number of incontinence episodes, suppressed detrusor overactivity, as well as treatment satisfaction and QoL [8–11].
A systematic review of the literature reporting on randomised controlled trials comparing treatments for faecal incontinence in adults
Published in Acta Chirurgica Belgica, 2019
Nikhil Lal, Constantinos Simillis, Alistair Slesser, Christos Kontovounisios, Shahnawaz Rasheed, Paris P. Tekkis, Emile Tan
Two crossover RCTs observed a preference of patients for the SNS ‘ON’ phase and a significant reduction in episodes of FI [48,49] (Supplementary Table 14). However, only one of the RCTs showed a significant change in the mean Wexner score during the ‘ON’ phase [48]. Tjandra et al. noted a significant change in the mean Wexner score, FI episodes per week and FIQL, in the SNS group compared to baseline, whereas, optimal medical management with bulking agents, PFMT and dietary manipulation showed no significant improvement [47]. Furthermore, a study observed a greater treatment effect with SNS than percutaneous tibial nerve stimulation (PTNS) [51] (Supplementary Tables 15 and 16).