Non-invasive massage technique to aid in removal of a tined sacral neuromodulation lead.

Introduction And Hypothesis: Describe a novel technique for retrieval of the Interstim lead in part based on techniques used in massage therapy.

Methods: Retrospective review of patients (single surgeon) identified by CPT code 64585 over 10 years. Exclusion criteria included patients who (1) had explantation for active infection or (2) did not proceed with a stage 2 implant (in the event of a staged procedure).

Sacral Neuromodulation and Twiddler's Syndrome.

Twiddler's syndrome is the deliberate, inadvertent, or subconscious manipulation of an implantable generator within its subcutaneous pocket that can lead to malposition and fracture of the associated lead. The syndrome is well recognized in patients with pacemakers, implantable cardioverter defibrillators, deep brain stimulators, and more recently in intrathecal drug delivery devices. Here we present an instance of Twiddler's syndrome after sacral neuromodulation.

Successful Treatment of Paradoxical Puborectalis Contraction and Intractable Anorectal Pain With Sacral Neuromodulation.

Background: Paradoxical puborectalis contraction (PPC) is a syndrome of obstructed defecation associated with a cluster of complaints including rectal pain, incomplete evacuatory sensation, prolonged repetitive straining with bowel movements, and the need for digital manipulation. Traditional treatment has yielded mixed results.

Case: We present a case of PPC successfully treated with staged sacral neuromodulation and review her diagnostic features, medical regimen, and prior unsuccessful interventions tried.

Safe Simultaneous Use of Sacral Neuromodulation and Vagal Nerve Stimulation.

Introduction: The potential for costimulation with competitive effects between implanted electronic devices remains speculative both at the level at the implanted device and with active programming but also at the retrograde site of action. We present a patient with an implanted vagal nerve stimulator for refractory epilepsy who underwent successful staged sacral neuromodulation (SNS) and benefits from both technologies.

Case: This is a case report of a 42-year-old female patient with a history notable for medically intractable epilepsy, temporal lobectomy, and vagal nerve stimulation who subsequently underwent staged SNS for refractory overactive bladder syndrome.

Serratia marcescens thigh infection after transobturator sling without associated mesh exposure.

Introduction: Soft tissue complications of the thigh occur after transobturator slings and are reported to uniformly accompany mesh exposure. Most commonly identified microorganisms cultured from such soft tissue infections include Bacteroides and Streptococcus species. This is the first reported case of Serratia marcescens leading to thigh cellulitis after a transobturator sling and the complication occurred in the absence of exposed mesh.

Laparoscopic mesh explantation and drainage of sacral abscess remote from transvaginal excision of exposed sacral colpopexy mesh.

Sacral colpopexy may be complicated by mesh exposure, and the surgical treatment of mesh exposure typically results in minor postoperative morbidity and few delayed complications. A 75-year-old woman presented 7 years after a laparoscopic sacral colpopexy, with Mersilene mesh, with an apical mesh exposure. She underwent an uncomplicated transvaginal excision and was asymptomatic until 8 months later when she presented with vaginal drainage and a sacral abscess.

Pre-ramus passage of inside-out transobturator sling.

Groin pain after transobturator tape is not uncommon. Differential diagnosis and treatment strategies are becoming elaborated in the literature. A patient presented with partial improvement in her stress incontinence and persistent groin and vulvar discomfort for 3 months after "inside-out" transobturator tape.

Subcapsular relocation for sacral neuromodulation pulse generator implant revision.

Objectives:   We describe our technique and experience with subcapsular placement of the Interstim (Medtronic, Minneapolis, MN, USA) pulse generator in cases of revision for implant site pain.

Methods:   The pulse generator and electrode are carefully exteriorized and the floor of the capsule is incised. The system is placed beneath the floor of the original capsule, which then becomes the roof of the new pocket.

Sacral neuromodulation and cardiac pacemakers.

Introduction And Hypothesis: Potential for cross-talk between cardiac pacemakers and sacral neuromodulation remains speculative.

Methods: We present a case series of patients with cardiac pacemakers who underwent staged Interstim (Medtronic, Minneapolis, MN) implantation and patients who had pulse generator implantation who later required cardiac pacemakers.

Results: No cross-talk was demonstrated in either group.

An unexpected cause of dyspareunia and partner dyspareunia following TVT-Secur.

TVT-Secur is a new "less" invasive derivative of the tension-free vaginal tape (TVT). We report an unusual case of dyspareunia for both the patient and her husband resulting from a retained finger pad from the TVT-Secur introducer. The sling was also explanted because of malposition.

Blunt trauma leading to delayed extrusion of sacral nerve implant.

Sacral neuromodulation is an effective treatment for refractory urge urinary incontinence, frequency, and urgency. Post pulse generator (IPG) adverse events requiring revision or explantation are typically pain, loss of response, and infection. We report a case of trauma-induced soft tissue injury and delayed extrusion of the IPG through the subcutaneous fat and skin.

Management of persistent groin pain after transobturator slings.

Prolonged groin pain after transobturator tape is uncommon. Three women reported groin pain that had not improved by 3 months postoperatively. Combined steroid and local anesthetic was effective for pain relief in all patients.

Expression profile of several genes in human myometrium and uterine leiomyoma.

Objective: To screen several genes that are differentially expressed in uterine leiomyoma and matched unaffected myometrium by using microarray-based hybridization and real-time polymerase chain reaction analyses.

Design: Screen by arrays for < or =2,400 known genes in leiomyoma and control myometrium.

Setting: University clinical research laboratory.

Interstitial cystitis in a woman with systemic mastocytosis.

Studies have reported detrusor mastocytosis in patients with interstitial cystitis. The author describes a patient with systemic mastocytosis who was confirmed to have detrusor mastocytosis and interstitial cystitis. She responded to therapy with pentosanpolysulfate.

Pyometra and recurrent prolapse after Le Fort colpocleisis.

The Le Fort colpocleisis is a surgical option for advanced pelvic organ prolapse in elderly and infirm women who no longer desire coital function. It is thought that the creation of adequate lateral drainage channels will prevent the occurrence of a pyometra. The author describes the occurrence of a pyometra, despite adequate vaginal channels, necessitating hysterectomy.

Sacral neuromodulation and lower urinary tract dysfunction in cerebral palsy.

Given the emerging role of sacral neuromodulation in treatment of neurogenic voiding dysfunction, the author describes the use of sacral neuromodulation in a patient with voiding dysfunction caused by cerebral palsy (CP). A 45-year-old patient with cerebral palsy presented with progressive complaints of urgency and overflow incontinence and was found to be in retention. She underwent sacral neuromodulation and had complete resolution of her symptoms.

Tuboovarian abscess: a postoperative complication of endometrial ablation.

Background: Global endometrial ablation may be associated with serious complications.

Case: We present a case of bilateral tuboovarian abscesses that developed 50 days postoperatively after a thermal ablation. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Stage II-B carcinoma of the cervix complicated by bilateral pelvic kidneys.

Background: The simultaneous occurrence of advanced cervical cancer and a pelvic kidney is uncommonly reported. It is an interesting clinical problem because the pelvic kidney lies within the radiation field.

Case: A patient found to have bilateral pelvic kidneys and stage II-B cervical cancer underwent an anterior exenteration.

Low-grade myofibroblastic sarcoma of the vulva.

Background: Vulvar sarcomas are rare tumors. A distinctive low-grade myofibroblastic sarcoma is described.

Case: A 46-year-old female presented with a progressively enlarging vulvar mass.

High dose rate intraoperative radiotherapy for recurrent cervical cancer and nodal disease.

Background: Patients with pelvic sidewall recurrences of cervical cancer have a dismal prognosis. Intraoperative radiation therapy (IORT) has demonstrated encouraging results. Patients have traditionally been excluded from IORT if they had distant metastases.

Effects of race and clinical factors on short-term outcomes of abdominal myomectomy.

Objective: To estimate the effects of race and preoperative uterine anatomy on complication rates after myomectomy.

Methods: A total of 239 abdominal myomectomies were performed at Duke University Medical Center from July 1992 through June 1998. Charts were abstracted using standardized forms.