Sacral nerve modulation for defaecation and micturition disorders in patients with spina bifida

“…We think that navigation using an O-arm could be beneficial in these cases. Lansen-Koch and associates [14] performed peripheral nerve evaluation for 10 patients with spina bifida: in two, PNE was not possible, 3/10 patients had more than 50% improvement and proceeded to a permanent implant, while in one patient it was not possible to perform the implantation. The authors performed an open operation to prevent damage to the nerves.…”

Section: Discussionmentioning

confidence: 99%

Sacral nerve stimulation lead implantation using the o-arm

et al. 2013

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BackgroundSacral neuromodulation operations have usually been performed based on 2D fluoro images. However, sacral nerve stimulation lead implantation may be challenging when the normal anatomy is confused by obesity or congenital anomalies. Thus the surgical navigation and intraoperative imaging methods could be helpful as those same methods have proven to be feasible methods for guiding other surgical operations. Our recent knowledge about the O-arm in trauma pelvic operations encouraged us to evaluate the usefulness of O-arm guided navigation in sacral neuromodulation. Similar navigation would be useful for complex sacral nerve stimulation lead implantations.MethodsIn this preliminary article we report our experience of utilizing the orthopedically optimized O-arm to implant the S3 stimulation electrode in a patient. The 3D O-arm imaging was performed intraoperatively under surgical navigation control. General anesthesia was used. The obtained 3D image dataset was registered automatically into the patient’s anatomy. The stimulation needle was guided and the tined lead electrode was implanted using navigation.ResultsThe bony sacral structures were clearly visualized. Due to automatic registration, the navigation was practicable instantly after the O-arm scanning and operation could be performed successfully under navigation control.ConclusionsTo our knowledge, this is the first published tined lead implantation which was guided based on the surgical navigation and intraoperative O-arm images. In this case, the applied method was useful and helped the surgeon to demarcate the region of surgical interest. The method is slightly more invasive than the formal technique but could be an option in anatomically challenging cases and reoperations. However, further evaluation with larger patient series is required before definitive recommendations can be made.

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“…SNM was found to have benefit in patients with incomplete SCI and concomitant pelvic functional disturbances (lower urinary tract symptoms, bowel dysfunction, erectile dysfunction) (33), (34). SNM was also studied in adult MMC patients for management of both fecal and urinary functional disorders, with promising preliminary results (35). With limited data, there was one study in 2 patients with partial SCI and fecal incontinence reporting improvement in fecal incontinence severity index and quality of life scales (36).…”

Section: Review Of Literaturementioning

confidence: 99%

Neurogenic Bowel Dysfunction in Patients with Neurogenic Bladder

Martínez

Neshatian

Khavari

2016

Curr Bladder Dysfunct Rep

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Patients with primary neurologic conditions often experience urinary and bowel dysfunction due to loss of sensory and/or motor control. Neurogenic bowel dysfunction is frequently characterized by both constipation and fecal incontinence. In general, the management of neurogenic bowel dysfunction has been less well studied than bladder dysfunction despite their close association.. It is widely accepted that establishment of a multifaceted bowel regimen is the cornerstone of conservative management. Continuing assessment is necessary to determine need for more invasive interventions. In the clinical setting, the Urologist may be the principle provider addressing bowel concerns in addition to bladder dysfunction, and furthermore, treatment of one often impacts the other. Future directions should include development of follow up and management guidelines that address the comprehensive care of this patient population.

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Sacral nerve modulation for defaecation and micturition disorders in patients with spina bifida

Abstract: Preliminary results of sacral nerve modulation in a subgroup of spina bifida patients with combined faecal and urinary functional disorders look promising, but long-term results in larger patient groups need to be studied.

Cited by 28 publications

References 27 publications

Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement

Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement

Sacral nerve stimulation lead implantation using the o-arm

Neurogenic Bowel Dysfunction in Patients with Neurogenic Bladder

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