In patients with pudendal neuralgia, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc.). This feasibility study reports on the initial experience of using a wireless system to power an implanted lead at the pudendal nerve, StimWave®, to treat pudendal neuralgia.Methods: Retrospective chart review identified patients with a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at Postoperative visits and phone calls. Administered non-validated followup questionnaire evaluated the Global Response Assessment, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (h/day of stimulation). Results: Thirteen patients had the StimWave® lead placed at the pudendal nerve, 12 (92%) female and 1 (7.6%) male. Mean age was 50 years (range: 20-58). Failed prior therapies include medical therapy (100%), pelvic floor physical therapy (92%), pudendal nerve blocks (85%), pelvic floor muscle trigger point injections (69%), neuromodulation (30.7%), or surgeries for urogenital pain (23.1%). After the trial period, 10/13 (76.9%) had >50% improvement in pain with 6/13 (46.1%) reporting 100% pain improvement. Nine underwent permanent lead placement. At last postoperative visit (range, 6-83 days), 5/9 patients reported >50% pain improvement. Seven patients reached for phone calls (22-759 days) reported symptoms to be "markedly improved" (n = 2), "moderately improved" (n = 4), or "slightly improved" (n = 1). At follow up, complications included lead migration (n = 2), broken wire (n = 1), or nonfunctioning antenna (n = 2).
Conclusion:Complex patients with pudendal neuralgia may benefit from pudendal nerve stimulation via StimWave®.
Hunner lesion interstitial cystitis (HLIC) is a form of interstitial cystitis/bladder pain syndrome (IC/BPS), occurring in 5%-57% of patients. HLIC is diagnosed by the presence of Hunner lesions on cystoscopy. Cyclosporin A (CyA) is an immunosuppressant that inhibits cytokine interleukin 2 transcription. Previous studies have shown that CyA is effective in the treatment of IC, but the
22Obstetrical and Gynecological Survey
After ileostomy surgery, patients require nutrition and hydration modifications to maintain electrolyte balances and prevent postoperative complications. In addition to becoming dehydrated, patients who have ileostomies can develop obstructions if care isn't taken to avoid certain kinds of foods. Moreover, changes to medications may be needed to manage ileostomy output or account for altered absorption. This article provides information on postoperative hydration, medication, and nutritional management to nurses caring for patients after ileostomy surgery.
(Abstracted from Female Pelvic Med Reconstr Surg 2021; doi: 10.1097/SPV.0000000000001108)Hunner lesion interstitial cystitis (HLIC) is a form of interstitial cystitis/bladder pain syndrome (IC/BPS), occurring in 5%–57% of patients. HLIC is diagnosed by the presence of Hunner lesions on cystoscopy.
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