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PubMedDate not supplied

Genitourinary applications of sacral neuromodulation.

Sacral neuromodulation provides a new option for the management of voiding dysfunction. For patients with intractable urge-incontinence, interstitial cystitis and non-obstructive urinary retention, this procedure has resulted in significant improvement in urinary frequency, voided volume and pelvic pain. We provide a review of the current literature on sacral neuromodulation and the West Virginia University experience with this procedure.

Electric Stimulation Therapy↗
PubMed2003

Scintigraphic and ultrasonographic assessment of the effect of lumbar sympathectomy upon chronic arteriosclerotic ischaemia of lower extremities.

The aim of the study was an evaluation of the effect of onesided lumbar sympathectomy in patients with peripheral vascular disease of lower extremity(ies), using perfusion scintigraphy with (99)mTc-MIBI and ultrasound Doppler blood flow-rate measurements. A secondary aim was a comparison of the diagnostic efficacy of the two techniques applied. The study was performed on 30 patients, studied prior to and early after one-sided lumbar sympathectomy. The scintigraphy yielded results indicating a statistically significant increase in perfusion of femoral and calf muscles (p < 0.001). Ultrasound investigation demonstrated significant (p < 0.001) increase of the maximal blood flow rate in the popliteal artery. Scintigraphic perfusion study yielded better agreement with the clinical evaluation than the ultrasound Doppler technique (83 v. 47 per cent, p < 0.01) and higher sensitivity in demonstration of improved blood supply (88 v. 36 per cent, p < 0.001).

Adult↗
PubMed2003

[Reconstructive surgery on the femoro-popliteal segment in combination with lumbar sympathectomy].

Long-term results of 660 reconstructive surgeries on the arteries of the femoro-popliteal segment performed from 1975 to 2002 are analyzed. Two hundred and twenty-eight (34.5%) of them were combined with lumbar sympathectomy (LSE) on the affected side. It was demonstrated that LSE influences outcomes of reconstructions on the femoro-popliteal segment. This influence depends on a primary degree of leg ischemia. At the stage of intermittent claudication LSE permits to improve patency of the femoro-popliteal segment, salvage of the leg, to decrease the rate of postoperative complications due to reduction of thrombosis and purulation rates. The rate of cardiovascular complications increases. In critical limb ischemia effect of LSE is opposite. It increases the rate of repeated occlusions and amputations compared with reconstructive surgeries without LSE. The rate of postoperative complications also increased due to thrombosis and cardiovascular complications. It is concluded that LSE is the factor improving outcomes of reconstructive surgery on the femoro-popliteal segment, but it must be used differentially. It is necessary to perform LSE during all reconstructive surgeries in patients with intermittent claudication and without serious cardiovascular diseases. In critical limb ischemia and serious concomitant cardiovascular diseases LSE must be avoided.

Femoral Artery↗
PubMed1992

Pudendal nerve palsy complicating intramedullary nailing of the femur.

A prospective study of 106 patients who had static interlocking nailing of the shaft of the femur was performed to determine the relationship between the duration and magnitude of intraoperative traction and the development of a pudendal nerve palsy. A strain-gauge, mounted in the countertraction post, measured the magnitude of the perineal pressure over time. All nailings were performed with the patient in the supine position. Postoperatively, the patients were interviewed by one of us, who had been blinded from the results of the recordings of intraoperative pressure, for a history of erectile dysfunction and changes in labial, scrotal, or penile sensation. A light-touch sensory examination of the genitalia was performed on all patients. Ten patients (six men and four women) had a pudendal nerve palsy: nine had sensory changes only, and one complained of erectile dysfunction. The symptoms had resolved at the three-month follow-up evaluation in all patients except one man who complained of dysesthesia six months postoperatively. The patients in whom a palsy did not develop had been positioned on the fracture-table and the perineal post for an average of 2.6 hours (range, 1.4 to 5.2 hours) compared with an average of 2.8 hours (range, 2.0 to 4.3 hours) for those in whom a palsy did not develop (p = 0.15). The magnitude of the total traction forces averaged 34.9 kilogram-hours for the patients who did not have a palsy compared with 73.3 kilogram-hours for those who did (p < 0.03). Adduction of the hip, as well as manipulations for reduction of the fracture, significantly increased the traction forces.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMedDate not supplied

[Ilioinguinal neuropathy: usefulness of conduction studies].

Ilioinguinal neuropathy is an under-recognized etiology of pelvic pain, that is frequently misdiagnosed with alternative etiologies of pelvic pain. This is partially due to the limited usefulness of neurophysiological studies. Indeed, electromyography of the lower abdominal musculature identifies slightly more than half of the cases. In spite of an available conduction technique described in normal subjects, the usefulness of nerve conduction studies in ilioinguinal neuropathy is uncertain because their use has not been validated with patients. We describe the case of a patient with left inguinal pain following left inguinal herniorraphy. He underwent repeated surgeries and several analgesic treatments, without amelioration of pain. Conduction studies were consistent with ilioinguinal neuropathy. Anesthetic block relieved symptoms temporarily, and the symptoms disappeared upon section of the ilioinguinal nerve. This case describes the usefulness of conduction studies in the diagnosis of ilioinguinal neuropathy.

Adult↗