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At least 361 records · Page 20Linked to original sources
PubMed2026

Sacral Neuromodulation in the Management of Refractory Pediatric Lower Urinary Tract Dysfunction.

INTRODUCTION: Sacral neuromodulation is currently used in the pediatric patient population for refractory lower urinary tract dysfunction (LUTD). Evidence, however, is currently limited for institutional experiences of long-term outcomes for sacral neuromodulation in the pediatric patient population. OBJECTIVE: The objective of this study is to perform a retrospective review of a large multi-institutional cohort of pediatric patients that underwent sacral neuromodulation (SNM) for refractory LUTD, focused on rates of symptom improvement, quality of life, and bowel-bladder dysfunction measures following device implantation. Secondary objectives included assessing device complication rates and device removals due to failure or successful resolution of symptoms. METHODS: We performed a retrospective cohort study of pediatric patients at three children's hospitals that underwent SNM device implantation for refractory LUTD. Patients 4-18 years of age who were diagnosed with refractory LUTD and managed at a participating institution with follow-up were included. Outcomes were evaluated at baseline and post-operatively after two-stage device implantation at initial follow-up and annually until device removal or final follow-up. RESULTS: From 2010 to 2022, a total of 205 children underwent SNM procedures at three pediatric hospital centers. 204 patients completed the two-stage procedure for permanent device implantation with a median follow-up of 3.4 years (1.3, 4.9). One hundred seventy-eight patients reported partial (25%) or complete (54%) device response/symptom improvement by final follow-up. Comparison of patient-reported validated questionnaires completed at baseline and by final follow-up visit revealed significant improvement in median Pediatric Quality of Life Inventory (PedsQL) (p&#x2009;=&#x2009;0.004) and Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome bowel-bladder dysfunction (BBD) scores (p&#x2009;<&#x2009;0.001). Of those with any device complication (n&#x2009;=&#x2009;43;21%), 19 patients required device revision, and 20 required complete device removal. Separately, twenty-eight patients (13%) underwent device removal due to resolution of symptoms or treatment success at a median period of 5 years (4,7). CONCLUSION: SNM use demonstrated a majority of patients reporting at least partial subjective symptom improvement following device implantation across multiple institutions by final follow-up. SNM is a viable treatment option for refractory LUTD in the pediatric patient if willing to undergo an invasive procedure and in which thorough counseling of risks and benefits has occurred.

Humans↗
PubMed1998

Spinal cord segments controlling the canine vas deferens and differentiation of the primate sympathetic pathways to the vas deferens.

This study was undertaken to explore the spinal cord segments controlling the canine and human vas deferens and differentiation of the mammalian sympathetic pathways to the vas deferens. Thoracolumbar white communicating rami (WCR) were electrically stimulated in the dogs. Stimulation of the 1st, 2nd, 3rd, and 4th lumbar WCR elicited an elevation of intraluminal pressure of the vas deferens in 2, 10, 16, and 14 of 20 dogs examined, respectively, whereas stimulation of sympathetic chain (between the 13th thoracic and 1st lumbar ganglia), 13th thoracic WCR, intermesenteric plexus, and 5th lumbar WCR showed no response in any of the 10, 2, 12, and 5 dogs examined, respectively. Anatomical study of the 118 human lumbar splanchnic nerves of 55 cadavers showed that almost all lumbar splanchnic nerves (96%) originated from L2 and/or L3 sympathetic chain ganglia (L1-2 spinal cord levels). Comparative anatomical study of the mammalian sympathetic pathways to the vas deferens showed that the caudal mesenteric plexus is not divided in rats, rabbits, cats, and dogs and is partially divided into two plexuses in monkeys and completely in humans and that separation of the sympathetic component in the pelvic nerve (isolation of the sacral splanchnic nerve) is in progress in the primate. These results indicate that spinal cord segments controlling the vas deferens are L1-4 in the dog and probably L1-2 in humans and that differentiation of the sympathetic nerve pathways is proceeding at both main and compensatory pathways to the vas deferens in the primate.

Animals↗
PubMed2001

Detection and inhibition of hyperreflexia-like bladder contractions in the cat by sacral nerve root recording and electrical stimulation.

Detection of bladder volume and hyperreflexive bladder contractions would be useful in individuals with overactive bladders. We sought to determine whether bladder filling and/or reflex bladder contractions could be detected by electrical recording from the sacral nerve roots, and whether bladder contractions could be inhibited by stimulation of sacral afferents. Six male cats were anesthetized with alpha-chloralose and bipolar cuff electrodes were used to measure sacral nerve root electroneurograms (ENG) during slow bladder filling, during rapid injections of fluid into the bladder, and during hyperreflexia-like bladder contractions. The rectified and time-averaged activity of the S1 extradural root increased by 0-5 % above the baseline during bladder filling. Rapid injections caused a sudden increase in bladder pressure, and a 3-36 % increase over baseline in the S1 nerve activity. Withdrawal of the same volume caused a reduction in pressure and a decrease in recorded activity (4-14 %). At the onset of a bladder contraction, there was a 7-38 % increase over baseline in the S1 nerve activity. This activity increase was sustained for the duration of the contraction and decreased during bladder relaxation. The onset and duration of bladder contractions could be detected consistently from these nerve activity changes. Recording only afferent activity showed that the increased nerve activity was due to S1 sensory rather than motor fibers. In two cats, it was demonstrated that an ongoing bladder contraction could be inhibited by rectal distension. In one cat, the contractions could be terminated by electrical stimulation of the S1 dorsal root. The results demonstrate that afferent sacral root nerve activity can be used to detect hyperreflexive bladder contractions at low bladder pressures. Such a signal might be used to trigger bladder inhibition via electrical stimulation of specific sacral afferents.

Animals↗
PubMed1984

The intramural pelvic nerves in the colon of dogs.

The intramural pelvic nerves of the dog colon were studied morphologically and electrophysiologically. These nerves emanate from the pelvic plexus, and ascend between the muscle layers along 57.5% of the colon's length. Many thin branches connect with Auerbach's plexus. Most of the nerves responded bilaterally with compound action potentials of A delta and C fibres to stimulation of the sacral dorsal roots, and with those of C fibres to stimulation of the ventral roots. Mean conduction velocities of the A delta and C fibres were 9.0 and 0.9 m/s, respectively. Distension of a section of colon at up to 85.0% of the length of the colon from the anus activated afferent fibres, and electrical stimulation of points at up to 102% of this length elicited responses in efferent fibres. In dogs in which the continuity of the colonic wall was interrupted by a ligature but the nerves were left intact, the intramural pelvic nerves were found to convey centrifugal activities of the recto- and ano-colonic reflexes to the proximal colon, and centripetal and centrifugal activities of the colo-colonic reflex.

Action Potentials↗
PubMed1981

[A case of sacral neurinoma].

A case of sacral neurinoma diagnosed in a 67-year-old woman whose clinical symptomatology consisted for fully 54 years of faint but persistent episodes of lumbo- and sacralgia is reported. Only at the terminal moment of observation did the patient present motor and sensitivity disturbances in the lower extremities, paralysis of the sphincters and sacral decubitus. The mass was identified radiologically and submitted to biopsy. It was localized in the left wing of the sacrum and on the corresponding side of the iliac bone, and presented a diameter of 6 X 9 cm. The slow, practically asymptomatic course, the exclusively intra-osseous site, the histological report and late onset of a cauda syndrome, suggest that the origin of the neoplasia lies in the sacral nerves.

Aged↗
PubMed1978

Macroscopical observations on a human anencephalous fetus with multiple malformations (author's transl).

The present report treats a female stillborn human anencephalous fetus with the craniorrhachischisis, cleft palate, left-sided congenital diaphragmatic hernia, hypoplasia of lungs, imperforate vagina and anus, absent left kidney and sternal muscle on the left side. In view of the rarity of the records of autopsied cases of anencephaly, authors made efforts to obtain informations on how all the organs in this fetus and their topographical relation in each other are affected by the anencephaly. The findings are summarized as follows. 1) This case falls under Anencephalus craniorrhachischisis in NANAGAS (1925)'S classification. 2) The greater part of thoracic and lumbar vertebral column except T10, 11, 12 and L1 segments shows several segmental malformations. The lumbar vertebral column is twisted towards right and the left posterior abdominal wall is nearly absent. Due to these changes, only two ribs are present on the left side. 3) In this case, there is a congenital diaphragmatic hernia through persistent left sided pleuroperitoneal canal. The abdominal viscera protruded into the pleural cavity are the caecum, vermiform appendix, colon, spleen and pancreas. 4) On both sides, the ventral rami of the thoracic, lumbar and sacral nerves are normal in number. Their spinal ganglia situated on these nerve roots are, however, fused to form eight ganglionic masses. 5) The five short left thoracic ventral rami arise from a ganglion lying on the posterior thoracic wall. This ganglion gives off the two branches communicating with the right 7th, 8th and 11th thoracic nerves. On the other hand, the right lumbar plexus receives the left 1st, 2nd and 3rd lumbar nerves. In the left pelvic part, there is another ganglion which gives off the two large branches to the right 1st and 2nd sacral nerves. 6) From the findings mentioned above, it is advisable to examine not only the ectodermal structures but also mesodermal ones to promote the studies on a factor in the genesis of anencephaly.

Abdomen↗
PubMed1983

Localization of neurotensin-immunoreactivity in the spinal cord and peripheral nervous system of the guinea pig.

The mapping of the regional distribution of neurotensin-immunoreactive (NT-IR) fibers and neurons is presented for cervical, thoracic, lumbal and sacral segments of the guinea pig spinal cord. The occurrence of NT-IR fibers in para- and prevertebral ganglia and intramural plexus of viscera is described. It is suggested that NT-IR fibers originating from neurons in the substantia intermedia of the spinal cord are connected with peripheral ganglia.

Animals↗
PubMed1995

Nerve sheath tumours in the dog and cat.

Schwannomas were diagnosed in twelve dogs and five cats at Massey University Small Animal Clinic and Hospital over a 15-year period (1977-92). A further two feline cases were reported at the Batchelar Animal Health Laboratory. In six dogs, the tumour involved nerves of the brachial plexus. Clinical signs observed in these dogs were forelimb lameness, muscle wasting and pain on movement of the affected limb or neck. Hindlimb paresis was observed in two dogs. Surgical excision of the brachial plexus tumour was attempted in one dog, leading to an 8-month remission of signs. In one dog, the tumour involved the sacral nerves, and in two dogs the cranial nerves were affected. Three dogs had skin nodules. Seven of the twelve affected dogs were destroyed. In five cats, the tumours developed on the carpus, tarsus or interdigital area of a forelimb or hindlimb as a slowly developing nodular lesion. In the other two cats, the site of the tumour was the flank and the lateral thigh respectively. Surgical excision of the tumour was successful in three cats.

Journal Article↗