The effect of sacral nerve modulation on cerebral evoked potential latency in fecal incontinence and constipation.

Objective: Influence of sacral nerve modulation (SNM) on cerebral somatosensory evoked potentials (SEP) was determined in patients with incontinence and constipation.

Background: Selection of patients with incontinence and constipation for SNM could be improved.

Methods: The latency (ms) of SEP induced by pudendal nerve stimulation was compared before (T0) and at 1 month during peripheral nerve evaluation (PNE) of SNM at frequencies of 21 Hz (T1) and 40 Hz (T2).

Interventional neurophysiology and an implantable system for neurostimulation of the sacral area.

Surgical or interventional neurophysiology is a term commonly used to refer to a large number of neurosurgical procedures involving the brain, cranial nerves, spinal cord and peripheral nervous system which, to be efficient and safe, demand specific neurophysiological know-how. As a result of the development of these procedures and their increasing use in the operating room, the role of clinical neurophysiology, traditionally diagnostic, has been extended. With the advent of 'neurostimulation' and 'neuromodulation', some neurophysiological techniques have, in themselves, progressively become more therapeutic, the therapeutic alteration of nervous system activity being achieved not only by surgical ablation or medication but also through electrophysiological means via implanted or non-implanted devices, whose development was made possible by extensive studies in the field of neurophysiology.

Daily intravesical instillation of 1 mg nociceptin/orphanin FQ for the control of neurogenic detrusor overactivity: a multicenter, placebo controlled, randomized exploratory study.

Purpose: We studied the feasibility, safety and efficacy of daily intravesical instillation of 1 mg of the endogenous peptide nociceptin/orphanin FQ in a selected group of patients who perform clean intermittent self-catheterization for neurogenic detrusor overactivity incontinence.

Materials And Methods: A total of 18 patients with neurogenic detrusor overactivity incontinence and on clean intermittent self-catheterization were prospectively randomized to receive 1 mg nociceptin/orphanin FQ in 10 cc saline (9) or placebo (saline) solution (9) at the first morning catheterization for 10 days. All patients completed a voiding diary using a frequency/volume chart according to International Continence Society guidelines, and reported daily incontinence frequency.

A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: description of the method and preliminary data.

Aims: Pudendal nerve stimulation has beneficial effects on numerous pelvic floor function impairments such as urinary and/or fecal incontinence, retention, and constipation. In preceding literature the implant technique required a fairly complex and invasive surgery, although recent advances with percutaneous placement of the lead through an introducer have made the procedure much less invasive. We performed staged procedure similar to that of sacral neuromodulation (SNM) to place tined lead near the pudendal nerve, using neurophysiological guidance that allowed accurate pudendal nerve stimulation through either perineal or posterior approach.

New sacral neuromodulation lead for percutaneous implantation using local anesthesia: description and first experience.

Purpose: In functional urology today chronic stimulation of the sacral nerves has become one of the most accepted methods of stimulation treatment. Many studies have described the advantage of test stimulation prior to implanting the definitive system to enable effective patient selection. We studied a method aimed at improving lead anchoring by developing a self-blocking electrode with a simple placement procedure, in the process creating a 2-stage approach to full percutaneous implantation that allows a long screening period during the first temporary stimulation stage.