Pudendal Nerve Stimulation for Bowel Dysfunction in Complete Cauda Equina Syndrome

George, Anil Thomas; Dudding, T. C.; Gurmany, Salma; Kamm, Michael A.; Nicholls, R. J.; Vaizey, C. J.

doi:10.1097/sla.0b013e31828e7602

Cited by 17 publications

(14 citation statements)

References 17 publications

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“…Evidently, the postoperative anorectal function must also be examined in detail. It is well known that the PVs provide the majority sensations and functions of the anorectum [28]. In our preliminary study using dogs, anorectal function recovery could be observed at six months after re-anastomoses of the PVs (data not shown).…”

Section: Discussionmentioning

confidence: 62%

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Araki

Sato²,

Naito

et al. 2013

PLoS ONE

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BackgroundAnorectal transplantation is a method for patients who have lost their anorectal function or suffer from congenital anorectal dysfunction to recover this function, and this has been investigated in experimental animal models using pigs, dogs, and rats. In this study, we performed an examination of anorectal transplantation in human cadavers to investigate whether this procedure could be performed in patients.MethodsA 77-year-old woman cadaver 1 was used as the donor and a 98-year-old woman cadaver 2 was used as the recipient. Initially, abdominoperineal excision of the anus and rectum (the Miles’ operation) was performed on the recipient. Next, an anorectal graft containing the pudendal nerve (PN), pudendal artery (PA), pudendal vein (PV), inferior mesenteric artery (IMA), and inferior mesenteric vein (IMV) was harvested from the donor. The donor graft was transplanted into the recipient by intestinal anastomosis and microneurovascular anastomoses orthotopically.ResultsThe diameters of the PN (right/left), IMA, and IMV were 2.5 mm/2.5 mm, 2.0 mm, and 1.5 mm, respectively, in cadaver 1, and 2.0 mm/2.0 mm, 2.0 mm, and 2.0 mm, respectively, in cadaver 2. The length of the PN, PA, PV, IMA, and IMV in the graft was sufficient to allow proper anastomosis.ConclusionThis preliminary study indicated that human anorectal transplantation was possible anatomically and technically. We anticipate our study will aid in the potential future application of this procedure to human patients.

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Section: Discussionmentioning

confidence: 62%

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Araki

Sato²,

Naito

et al. 2013

PLoS ONE

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“…Pudendal nerve stimulation in cauda equina subjects was investigated in a recent study with promising results. 20 Other treatment modalities of interest are posterior tibial nerve stimulation, dorsal genital nerve stimulation and magnetic stimulation. 19 Other aspects which may have limited the use of SARS are a long learning curve to perform the surgical procedure, subject selection, knowledge on stimulator setup, troubleshooting when errors occur and known complications to the surgical procedure (cerebrospinal fluid leakage and infection).…”

Section: Discussionmentioning

confidence: 99%

Sacral anterior root stimulation improves bowel function in subjects with spinal cord injury

et al. 2015

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Study design: Cross-sectional study. Objective: To evaluate the long-term effect of the sacral anterior root stimulator (SARS) on neurogenic bowel dysfunction in a large, well defined spinal cord injury (SCI) cohort. Setting: Department of Neuro-Urology, Bad Wildungen, Germany. Methods: Subjects undergone surgery at for SARS-SDAF (sacral deafferentation) between September 1986 and July 2011 (n = 587) answered a questionnaire. In total, 277 SARS subjects were available for the baseline (recall) and follow-up comparison. Results: Median age was 49 years (range: 19-80), time from SCI to surgery was 10 years (range: 0-49) and from surgery to follow-up 13 (range: 1-25). Of the responders 73% used SARS for bowel emptying. On visual analog scale (VAS) ranging from 0-10 (best), satisfaction with SARS was 10. Baseline and follow-up comparison showed a decline in the median VAS score 0-10 (worst) for bowel symptoms from 6 (range: 4-8) to 4 (range: 2-6), Po0.0001; median neurogenic bowel dysfunction score from 17 (range: 11-2) to 11 (range: 9-15), Po0.0001; median St Marks score from 4 (range: 0-7) to 4 (range: 0-5), P = 0.01; and median Cleveland constipation score from 7 (range: 6-10) to 6 (range: 4-8), Po0.0001. Use of suppositories, digital evacuation and mini enema and subjects totally dependent on assistance during defecation were significantly lower after SARS. Conclusions: The SARS has the potential to be one of the few treatment methods targeting multiple organ dysfunctions following SCI.

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“…It also impacts on the anal muscles and causes fecal incontinence, impotence and insensibility in the saddle area. Acute symptoms of this syndrome include pain in the leg and severe back pain and strict sense changes in saddle shaped area (genitals, urethra, anus, inner tights) like urinary retention and incontinence that need for hospitalization (8-11). This syndrome is classified into two types of complete (or CES with true retention; CESR) and incomplete (incomplete CES; CESI).…”

Section: Introductionmentioning

confidence: 99%

Examination of The Predictive Power of Electromyography and Urodynamic Study in Patients with Cauda Equina Syndrome (Horse Tail Syndrome)

et al. 2016

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Background:Cauda equina syndrome is a rare disorder that causes loss of Lumbar plexus function (nerve roots) lower than conus medullaris. No risk factor has been defined for this disease yet. Due to the high morbidity of Cauda equina syndrome and lack of sufficient information about the connection between the disease and urodynamic findings and EMG (Electromyography) findings, the need for this comprehensive study is felt.Objective:The aim is to determine the predictive power of findings resulted from urodynamics and electromyography of perineal region and around sphincter in the clinical cure rate of urination in patients with urinary retention followed by Cauda equina syndrome.Method:Patients referred to Shohadaye Tajrish Hospital during the years 2009 to 2013, in case of having Cauda equina syndrome symptoms (confirmed with Lumbar MRI), were undergone urodynamic examination and perineal electromyography after surgical decompression action. These both assessments (urodynamic study and electromyography) were repeated during the follow-up of 15 patients in the first and sixth months after surgery and findings were compared with each other.Results:Among the Urodynamic findings, Qmax (maximum urine flow) during three studies had a significant relationship with long-term recovery rate of patients (P <0.05). The relationship had been more valuable in follow-ups after one month (P = 0.0001). Also, BCI (Bladder Contractility Index) in all three studies had a significant relationship with clinical improvement in the ability to urinate (P <0.001). The residual urine (PVR) compared to two previous urodynamic findings showed a less significant relationship with clinical cure rate (P = 0.04). Among the findings of muscle-nerve (MUAP Fibrillation, Positive sharp way) none of them had a significant relationship with cure rate.Conclusion:Urodynamic finding, especially Qmax and bladder contractility index, can be considered as predictive indicators for patients’ recovery after surgery.

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Pudendal Nerve Stimulation for Bowel Dysfunction in Complete Cauda Equina Syndrome

Abstract: PNS is an effective treatment in the short term for bowel dysfunction in some patients with complete CES.

Cited by 17 publications

References 17 publications

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Anorectal Transplantation in Human Cadavers: Mock Anorectal Allotransplantation

Sacral anterior root stimulation improves bowel function in subjects with spinal cord injury

Examination of The Predictive Power of Electromyography and Urodynamic Study in Patients with Cauda Equina Syndrome (Horse Tail Syndrome)

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