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At least 1,009 records · Page 56Linked to original sources
PubMed2003

[Sacral neuromodulation in patients with nonobstructive, chronic urinary retention: relevance of the carbachol test and influence of associated nerve lession].

OBJECTIVE: Aim of this study was to evaluate whether the carbachol test and the nerve lesions responsible for bladder dysfunction possess predictive value in patients with chronic urinary retention who undergo temporary sacral neuromodulation (PNE test). MATERIAL AND METHODS: In 1999 and 2000, PNE tests were performed in 24 patients with chronic urinary retention and acontractile detrusor previously assessed by urodynamics. In 18 patients, a carbachol test was performed during urodynamics. The diagnosis related to the acontractile detrusor was additionally assessed and compared to the successful outcome of the PNE test. RESULTS: The PNE test was successful in 8 of the 24 patients (33.3 %). The bladder was completely emptied during the PNE test in 3 of the 10 patients with negative carbachol test and in 3 of the 8 patients with positive carbachol test. The highest success rate (80 %) was observed in patients after hysterectomy, whereas after lumbosacral pulposal prolapse or with a CNS tumor, it was only 20 - 33.3 %. CONCLUSIONS: We conclude that sacral neuromodulation is an effective treatment option in patients with nonobstructive urinary retention. The carbachol test does not possess any definitive predictive value with respect to the success rate of sacral neuromodulation in patients with chronic urinary retention. The success rate more likely depends on the localisation of the nerve lesion. PNE tests should be performed in all patients with therapy resistent nonobstructive urinary retention, as no other predictive factors exist.

Adult↗
PubMed2003

[Clinical Results of PNE Tests in 70 Patients with Different Bladder Dysfunctions].

PURPOSE: Prior to implantation of a sacral neuromodulator we carried out PNE tests (peripheral nerve evaluation test) with bilateral test stimulation to establish which patients might profit from this kind of therapy. In contrast to the original unilateral technique used by Tanagho and Schmidt, we performed bilateral PNE test stimulation. Moreover, we analysed the diagnostic characteristics of those patients who had positive PNE test results and could thus receive a chronic sacral neuromodulator. MATERIALS AND METHODS: We performed bilateral PNE test stimulation in 70 patients (mean age: 53.6 yrs; 41 with retention symptoms and 29 with a hyperactive detrusor) over a minimum of 3 days. Retrospectively, we analysed the distribution of diagnostic characteristics (retention vs. overactive bladder and neurogenic vs. idiopathic) in the implant recipients. RESULTS: All patients received bilateral PNE test stimulation, during which the stimulation amplitudes were adjusted individually for each side. 8 patients were treated with the original PNE-electrode (model 0 041 830 - 002, Medtronic Inc., USA) without success. Of the remaining 62 patients, who were treated with an improved electrode, the PNE test was successful in 32 cases (51.6 %). Twenty-seven of these patients suffered from a neurogenic bladder dysfunction, and, in 5 cases, the causes were idiopathic. CONCLUSIONS: Bilateral PNE-test stimulation and the use of advanced PNE electrodes (model 3057, Medtronic Inc., USA) led to a positive PNE result in 51.6 % of the tested patients. Of these, the group with neurogenic bladder dysfunctions showed the highest response rate. Compared with the success rates in the multicenter study, we were able to increase the overall PNE response rate significantly. For this reason, we prefer a bilateral PNE-test with side-specific stimulation.

Adult↗
PubMed2006

[Use of permanent electrodes in the peripheral nerve evaluation test (PNE-Test) in comparison to conventional wire electrodes].

PURPOSE: Prior to implantation of a chronic sacral neurostimulator, it is important to establish which patients might profit from this kind of therapy in order to ensure, by means of a PNE (peripheral nerve evaluation) test, that the implantation of a permanent stimulating device is effective. In this study we compared the two different techniques used in our department (implantation of the permanent neurostimulation electrodes, the so-called "two-stage-implantation" vs. conventional PNE). MATERIALS AND METHODS: We performed a sacral nerve stimulation in 53 patients (mean age: 49.7 years, range: 14 - 75 years) over a minimum of 5 days. In 42 patients we performed a conventional PNE, 11 patients underwent "two-stage implantation" with implantation of the permanent electrodes. RESULTS: 52 of 53 patients received bilateral test stimulation (9 % at S2, 91 % at S3). One patient underwent unilateral PNE (S3) because of an anatomic deformity of the os sacrum. In 20 cases the conventional PNE-test (cPNE) was successful according to standard criteria (47.6 % of all cPNE). The response rate of "two-stage implantation" with implantation of the permanent electrodes was 81.8 % (9 of 11 patients). CONCLUSIONS: The success rate of implantation of permanent neurostimulation electrodes in selecting patients for the permanent implant is significantly higher than the conventional PNE. In this group patients with neurogenic and overactive bladder dysfunctions showed the highest response rates to sacral nerve stimulation and are the most likely to benefit from sacral neuromodulation.

Adolescent↗
PubMed1997

[CT-guided intervention by means of a laser marking and targeting aid].

PURPOSE: The present study evaluates the use of a laser guidance system for CT-guided intervention. MATERIAL AND METHODS: 94 cases of diagnostic biopsies and lumbar sympathectomies (54 cases with laser guidance system and 40 without) were compared. RESULTS: Using the laser guidance system, the number of control scans decreased by 30 to 50%, and necessary corrections of needle location were reduced by a maximum of 30%. The average target deviation of the needle decreased to less than 5 mm in 50% of cases. CONCLUSION: The laser guidance system is strongly recommended in CT-guided interventions for quality assurance and higher efficiency. The advantage is especially marked if the target area is small.

Adolescent↗
PubMed1993

[Postoperative pain therapy following total endoprosthetic surgery on the hip using a continuous 3-in-1 blockade].

40 patients who had undergone total hip replacement were included in a randomised prospective study. Postoperative pain management was performed with a continuous 3-in-1 block combined with demand-adapted intravenous meperidine titration (3-in-1 catheter group; n = 20) or by demand-adapted intravenous meperidine titration alone (control group; n = 20). The 3-in-1 catheter was placed before the start of anesthesia, and the patients received 30 ml 0.5% bupivacaine via this catheter. A second dose of 30 ml 0.5% bupivacaine was injected 10 min after postanaesthetic recovery. In the control group intravenous meperidine titration was initiated if the patients required pain relief. Subjective pain intensity was evaluated over a 6-hour period by means of the visual analogue scale. Bupivacaine plasma concentrations were determined in 18 patients at 30, 60, 120, and 180 min after the first postoperative injection of bupivacaine. Good pain control was achieved in both groups. The patients in the control group required a mean of 80.8 +/- 49.9 mg meperidine. The 3-in-1 block group required significantly less meperidine (54.3 +/- 44.5 mg). Mean bupivacaine plasma levels ranged between 0.75 and 1.33 micrograms/ml. Placement of the 3-in-1 catheters was without complications. For the management of postoperative pain following total hip replacement a continuous 3-in-1 block alone was often insufficient but postoperative meperidine requirements were significantly reduced (p < 0.05). Toxic bupivacaine plasma concentrations were not measured.

Aged↗
PubMed1988

[Magnetic resonance tomography of the perineural cyst].

It may be difficult to differentiate between symptomatic perineural cysts, arachnoidal cysts, meningoceles, neurinomas and other cystic masses within the spinal canal and spinal foramina. Therefore the impact of MRI on the differential diagnosis of these lesions is discussed on the basis of 15 cases with perineural cysts, 1 case of an arachnoid cyst, 2 cases of meningoceles and 2 cases of neurinomas. The problem of fluid characterisation by the use of special MR measurements is emphasised.

Adult↗
PubMed1984

[Transabdominal CT-guided sympathectomy].

A new technique for lumbar sympathectomy is described. It consists of CT-guided trans-abdominal fine needle puncture and injection of alcohol. The technique is simple and well tolerated by the patient, and it permits accurate application of the alcohol. Complications have so far not been observed.

Aged↗
PubMed2002

Surgical sympathectomy for reflex sympathetic dystrophy syndromes.

PURPOSE: The purpose of this study was the assessment of the efficacy of thoracoscopic cervicodorsal and open lumbar sympathectomy for the reduction of pain severity and disability associated with reflex sympathetic dystrophy (RSD). METHODS: From 1992 to 2000, 73 patients with RSD underwent 46 video-assisted thoracoscopic (first to fourth thoracic ganglion) or 37 surgical lumbar (first to fourth lumbar ganglion) sympathetic chain resections. The patients were referred from multidisciplinary pain clinics with documented sympathetically maintained pain syndrome on the basis of reproducible more than 50% reduction in pain severity score (0, no pain; 10, most severe pain imaginable) for more than 2 days after sympathetic block therapy. The mean duration of the RSD symptoms before sympathectomy was 26 plus minus 14 months (range, 6 to 100 months). Postoperative pain severity score, limb disability, and overall patient satisfaction were assessed by an independent third-party observer at a mean follow-up period of 30 months. RESULTS: No operative mortality or serious morbidity (Horner's syndrome, bleeding that needed transfusion, wound infection) occurred. Transient (<3-month) postprocedural sympathalgia developed in one third of the patients for cervicodorsal sympathectomy and 20% of the patients for lumbar sympathectomy and was treated effectively with trigger point/proximal ganglion block therapy or transcutaneous electrical nerve stimulation. At 3 months after sympathectomy, 10% of the patients had conditions that were judged treatment failures with no reduction in pain severity or limb disability. The remaining patients testified to more than 50% pain reduction, with pain severity scores decreasing from a mean of 8.7 before surgery to 3.4 after sympathectomy. At 1 year, one quarter of the patients had continued significant pain relief (pain severity score, <3) and an additional 50% of the patients indicated continued but reduced pain severity and an increase in daily/work activities. Overall, patient satisfaction (willingness to have procedure again, benefit from sympathectomy) was 77% and was not significantly influenced by patient age, RSD duration/stage, or extremity involvement (lumbar, 84%; cervicodorsal, 72%). CONCLUSION: Patients with RSD with a confirmed sympathetically maintained pain syndrome can realize long-term benefit from surgical sympathectomy. Procedural efficacy was similar for both upper limb and lower limb RSD syndromes, although the level of pain reduction did deteriorate with time. After sympathectomy, the patients with RSD had a low incidence rate (7%) of "new" complex regional pain or disabling compensatory sweating syndromes.

Adolescent↗
PubMed1997

Brain-derived neurotrophic factor regulates expression of androgen receptors in perineal motoneurons.

Motoneurons in the spinal nucleus of the bulbocavernosus (SNB) express androgen receptors and innervate striated muscles attached to the penis. Previous studies indicated that androgen receptor immunoreactivity in the SNB motoneurons decreases after axotomy and returns to normal only in motoneurons allowed to reinnervate their muscle targets, suggesting that neuron-target interactions play a role in regulating steroid receptor expression in the central nervous system. This study demonstrates that (i) silencing the SNB neuromuscular system with tetrodotoxin did not affect androgen receptor expression in these motoneurons, suggesting that the regulation of androgen receptor is activity-independent; (ii) disruption of axonal transport with vinblastine caused a down-regulation of androgen receptor expression in the SNB motoneurons; and (iii) treatment with brain-derived neurotrophic factor, but not ciliary neurotrophic factor, neurotrophin-4, or glial cell line-derived neurotrophic factor, reversed the axotomy-induced down-regulation of androgen receptor expression. These findings demonstrate neurotrophin regulation of steroid receptor expression in the central nervous system in vivo.

Animals↗
PubMed1999

The neuronal control of the lower urinary tract: A model of architecture and control mechanisms.

The human micturition cycle is controlled by central and peripheral nervous structures and connections. In literature, no complete or generally accepted model describes the principles of micturition control. In this paper, the integration of (neuro-)anatomy, (neuro-)physiology and control theory is used to describe and model the neuronal control of the lower urinary tract. Neuroanatomy supplies the most basic information necessary for the modellation of the peripheral pathways and central connections involved in the control of the uropoetic system. It is found that not all the nervous structures and connections have been identified as such yet. The linking up between several nervous structures (e.g., the presence of central and peripheral relay stations) is not completely clear. A s a consequence, each model to describe the micturition cycle from the perspective of control theory is yet of limited physiological value as it cannot exceed a rather general level of modellation. Adding functional considerations (neurophysiology and control theory) to the neuroanatomical skeleton completes the model. Some control mechanisms active during the micturition cycle can still not be revealed in detail. Crucial questions on the neuronal innervation of the human uropoetic system and the control mechanisms active during the micturition cycle remain, like how the supraspinal trigger mechanisms for micturition are organised, or how the voluntary cessation of voiding is realised. A simplified version of the model discussed in this paper can already be used for mathematical modelling, e.g., neural network simulations.

Afferent Pathways↗
PubMed2000

First Scandinavian experience of electrical sacral nerve stimulation in the treatment of the overactive bladder.

OBJECTIVE: This study aimed to evaluate the efficacy of electrical sacral nerve stimulation (SNS) in the treatment of urinary incontinence and urinary retention refractory to conservative treatment, and to assess the impact of urodynamic abnormalities and electrode position. MATERIAL AND METHODS: Thirty patients (10 men, 20 women) with a mean age of 59 years (range 21-79 years), all of whom had longstanding symptoms ranging from 2 to 46 years (mean 12.4 years), were subjected to a percutaneous test stimulation. Ten patients responded well, resulting in a permanent implant in nine patients. Electrode positions were determined by plain X-ray and computed tomography. RESULTS: Radiologically, a variety of positions of the temporary electrodes was seen. In the implanted patients, long-term symptom reduction varied over time, ranging from total relief to partial or total recurrence of symptoms. CONCLUSIONS: SNS is a new promising option for the treatment of urge incontinence. Refined instruments for proper patient selection and the optimal way to position the electrode remain to be developed.

Adult↗
PubMed2004

Sacral nerve stimulation for refractory urge symptoms in elderly patients.

OBJECTIVE: The presence of an overactive detrusor (OD) is becoming more prevalent in the elderly and may severely influence the social life and activities of daily living in the senior, otherwise healthy, person. There is a marked age-dependent increase in OD above the age of 65 years, which is mainly attributed to dysfunction, with loss of voluntary control, of the micturition reflex and decreased perception of bladder fullness. MATERIAL AND METHODS: Herein, we evaluate the outcome of sacral nerve stimulation in five patients aged >65 years derived from a large, multinational, randomized, prospective study. RESULTS: The effect on symptoms was excellent in two subjects. There was a moderate improvement in another subject and a variable but eventually small effect in the remaining two patients. The results appeared to be more favourable in younger patients. CONCLUSION: Our findings suggest that the outcome of sacral nerve stimulation is more unpredictable in the elderly, a fact that should be considered when counselling the patient. However, it should be remembered that, even for the older, active person, urge incontinence may have a severe impact on quality of life and that the majority of patients treated with an implant will benefit from this treatment.

Aged↗
PubMed2006

Muscle fibrillation as a sign of electrode damage in sacral neuromodulation.

Sacral root neuromodulation is recognized as an effective therapy for chronic voiding dysfunction. However, knowledge about the neuromodulator in the general medical community is scarce. We report a case of muscle fibrillation caused by current leaking from a neuromodulator lead which had been damaged during disc prolapse surgery.

Adult↗
PubMed1999

Properties of endothelium and smooth muscle cells in canine femoral arteries after lumbar sympathectomy.

OBJECTIVE: To find out whether the lumbar sympathectomy modulated the endothelial function (as measured by nitric oxide (NO) and prostacyclin (PGI2), and blood flow in the canine femoral artery. DESIGN: Laboratory experiments. SETTING: Teaching hospital, Japan. ANIMALS: 16 mongrel dogs. INTERVENTION: Unilateral sympathectomy from L3 to L6. MAIN OUTCOME MEASURES: Five weeks later, the changes in blood flow, the endothelium-dependent responses and the PGI2 production in the canine femoral arteries were measured. RESULTS: The median (range) blood flow of left (denervated) and right (innervated) femoral arteries was 162 ml/min (122-330) and 65 ml/min (40-92), respectively. There was a significant difference between the two groups (p < 0.01). The endothelium-dependent relaxations to acetylcholine, adenosine diphosphate (ADP) and A23187 were comparable. The amounts of PGI2 produced in the two groups were similar. Direct relaxation in response to sodium nitroprusside was also similar in the two groups. CONCLUSIONS: Lumbar sympathectomy did not alter the endothelial function, although the median blood flow in the denervated femoral arteries was significantly higher than in the innervated ones. The continuous vasodilatation after sympathectomy may be a more potent factor in the regulation of vascular tonus than the physiological regulation of NO and PGI2.

Animals↗