The anus and anal canal
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
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.
Chronic Pelvic Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
An alternative to actual ablation of nerve fibers is neuromodulation. Neuromodulation techniques include sacral nerve stimulation, retrograde nerve root stimulation, and selective stimulation of the S2, S3, and S4 nerve roots. Retrograde stimulation involves implanting four quadripolar leads by a trained specialist with adequate experience because complications can include wet taps and intrathecal electrode implantations (Feler et al., 2003). Another option that has been considered is superior hypogastric nerve block using neurolytic agents such as 10% phenol or 50% ethanol under fluoroscopic guidance. A small uncontrolled study of 10 patients using Transforaminal sacral nerve stimulation with an implantable neuroprosthetic device showed that 9 of 10 patients with the implant had a decrease in the pain severity of the worst pain compared with baseline at a median follow-up of 19 months (Siegel et al., 2001). There was an average decrease in the rate of pain from 9.7 at baseline to 4.4 on a scale of 10 = always to 0 = never having pain (Siegel et al., 2001).
Neurosurgery
Brian J Pollard, Gareth Kitchen in Handbook of Clinical Anaesthesia, 2017
Sacral nerve stimulation was initially developed for patients with urinary retention but is now employed to treat faecal incontinence, constipation and chronic pelvic pain. Sacral nerve stimulators can be inserted under local or general anaesthesia. During the initial trial, an incision is made over the lower back and the electrodes placed in contact with the sacral nerve roots. These are then connected to an external stimulator for a period of about 2–3 weeks. If successful, the leads are then tunneled beneath the skin to the buttock or lower abdomen, where the pulse generator is sited.
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)
Sacral neuromodulation for female pelvic floor disorders
Published in Arab Journal of Urology, 2019
Ahmed S. El-Azab, Steven W. Siegel
We conducted a literature search using PubMed and Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [4]. The literature search was from 1998 to 2018, in the English language and using the keywords: ‘sacral neuromodulation’ and ‘sacral nerve stimulation’, ‘female pelvic floor disorders’, ‘lower urinary tract symptoms’, ‘overactive bladder’, ‘urinary retention’, ‘chronic pelvic pain’, and ‘painful bladder syndrome’. We limited our search to randomised controlled trials (RCTs) and prospective studies. Retrospective studies were included when no prospective studies were available. We limited our search to studies assessing the effectiveness and safety of SNM in various female pelvic floor disorders with a good sample size and acceptable follow-up period. After applying these criteria, a total of 124 papers were eligible to be included. The authors then evaluated the articles based on study design, sample size (≥25 patients), and outcome measures. Studies with heterogeneous patient populations or those with no preoperative stratification of patients into groups based on the specific indications were excluded. Finally, 19 articles were included in our systematic review (Figure 1).
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).
Related Knowledge Centers
- Constipation
- Foramen
- Neuromodulation
- Spinal Nerve
- Urinary Incontinence
- Urinary Retention
- Pelvic Floor
- Subcutaneous Tissue
- Functional Electrical Stimulation
- Frequent Urination