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At least 1,423 records · Page 79Linked to original sources
PubMed2003

[Treatment of urge incontinence by sacral neuromodulation in two patients with artificial sphincters].

Patients with stress urinary incontinence due to major sphincter incompetence are sometimes treated by artificial urinary sphincter (AUS). Some patients with AUS subsequently develop urge incontinence that is refractory, to pharmacological treatments. Sacral neuromodulation could constitute an alternative treatment in these cases. The authors report two patients treated by the combined use of these two implants with a follow-up of 24 months. The efficacy of sacral neuromodulation in this indication appears to be satisfactory. The presence of the AUS does not appear to modify the action of the neuromodulator.

Aged↗
PubMed2004

Parameters of successful sacral root neuromodulation of the pelvic floor: a retrospective study.

INTRODUCTION/OBJECTIVE: Neuromodulation of the pelvic floor (InterStim) is a relatively new technique in the field of urology. We present our observations for effective neuromodulation on our patient population. MATERIALS AND METHODS: In a retrospective case review study, we studied the charts of 67 patients, who underwent InterStim operations between the years 1993 to 2002. All patients had a good response to InterStim. Patients with inefficient or inconclusive responses were not included in the study. All the relevant patient data was recorded from their charts. For each patient, the following was recorded; the amplitude in volts, the pulse width (in microseconds) and rate, the mode (cycling versus continuous), the electrodes and their position, the load impedance, and the change in amplitude over time. RESULTS: Amplitude over time showed an initial plateau, followed by a small increase that gets larger. CONCLUSIONS: Long-term management of InterStim recipients requires increasing amplitude following the implantation of the IntreStim to maintain the same satisfactory levels of urinary control.

Adult↗
PubMedDate not supplied

Femoral nerve injury complicating continuous psoas compartment block.

OBJECTIVES: The objective of this case report is to describe a femoral nerve injury after a psoas compartment block (PCB) and to discuss the probable mechanisms of injury and neuron regeneration. To date, this is the first report of severe femoral nerve injury after PCB. CASE REPORT: A 60-year-old, American Society of Anesthesiologists II woman underwent right total knee replacement under general anesthesia and continuous PCB for postoperative analgesia. Postoperatively, she showed signs of severe femoral nerve injury. A physical therapy program and muscle electrical stimulation were instituted and continued for 6 months. The patient recovered completely with no residual motor or sensory deficit and had no other complication. CONCLUSIONS: Severe nerve injuries after regional anesthesia techniques remain infrequent and probably unreported. Our case report suggests that severe femoral nerve injury should be added to the list of reported complications during PCB. This case report is also encouraging because it shows the possibility of a good recovery after such injury.

Anesthesia, General↗
PubMed2004

[Assessment of thoracic sympathectomy by transpleural posterolateral and thoracoscopic approach in surgical treatment of Raynaud's syndrome].

Operative treatment of patients with Raynaud's Syndrome is rarely used, and is recommended by most authors only in the case of disthrophic changes or so advanced symptoms, which disturb normal social and daily life. Recently, thoracoscopic sympathectomy is applied more frequently. The aim of this study was to assess the usefulness of thoracoscopic sympathectomy by the presentation of early and long-term outcome of 43 thoracic and eight lumbar sympathectomies performed in 41 patients with Raynaud's Syndrome. Transpleural posterio-lateral thoracotomy was performed 29 times in 27 patients, whereas thoracoscopic sympatectomy 14 times in 8 patients. Surgical techniques, early and long-term results were discussed. Based on early and long-term outcome, there were no significant differences between applied surgical techniques. Moreover, thoracoscopic sympathectomy was safe in the aspect of a short duration as well as good therapeutic and cosmetic effect of the procedure. It should be applied instead of others, so far used methods, with the exception of patients with massive pleural adhesions, which need thoracotomy.

Adult↗
PubMedDate not supplied

Retroperitoneoscopic lumbar sympathectomy for buerger's disease: a novel technique.

BACKGROUND: The conventional lumbar sympathectomy procedure through the extraperitoneal route requires a muscle cutting-splitting incision, which leads to significant postoperative pain and prolonged convalescence. With increasing experience in retroperitoneoscopic procedures, we did a pilot study to explore the role of retroperitoneoscopy in lumbar sympathectomy. We describe herein our technique used for the surgery. METHODS: The patient was placed in a lateral position. A 15-mm incision was made just below the 12th rib, and retroperitoneal space was created using blunt finger dissection. A custom-made, large balloon was inserted and inflated with the equivalent of 750 mL to 1000 mL of saline. The second 10-mm port was placed in line with the first port above the iliac crest. The third and fourth 5-mm ports were placed anterior to the first 2 ports. Peritoneum was retracted anteriorly. The medial border of the psoas muscle was used as a landmark and a chain identified immediately medial to it. Lumbar vessels were ligated on the right side. The first to fourth lumbar sympathetic ganglia were removed with the intervening chain. The port sites were closed without a drain. RESULTS: We attempted and successfully completed this procedure in 8 patients; 6 on the left side and 2 on the right side. The average operating time was 38 minutes. The mean hospital stay was 1.5 days. All patients had symptomatic pain relief and clinical improvement. CONCLUSIONS: Retroperitoneoscopic lumbar sympathectomy is a safe and effective procedure. It has a short convalescent time and minimal morbidity; hence, it is a viable alternative for the open procedure.

Adult↗
PubMed2004

[Sacral nerve stimulation in fecal incontinence; efficacy and safety].

Fecal incontinence is common due to various reasons. Conservative therapy of fecal incontinence may sometimes be effective in improving function, but usually many patients require surgery. Sacral nerve stimulation is another treatment modality which gained interest, and appears to be an alternative method that is successful with low morbidity. With the approval of the local ethical committee a total of 14 patients with rectal incontinence had undergone trial stimulation of sacral neuromodulation after failure of conservative treatment modalities. The implantations were performed under surgical sterile conditions with fluoroscopic guidance through the S3 foramen. After correct placement 0.5-2 V, 15 /min, pulse width 210 micro s stimulus was given. The patients had trial period longer than 6 weeks; 9 of 14 patients responded positively to the trial period. Of these 1 had permanent implantation, 3 were booked for permanent implantation, and 2 of the patients had complete incontinence relief from the trial period. Evaluating the data and the results of our study we may conclude that sacral nerve stimulation is an emerging surgical technique to produce a clinically beneficial physiological effect on the lower bowel, pelvic floor and anal canal.

Electric Stimulation Therapy↗