Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: Results in 40 patients

Ganio, Ezio; Masin, Alessandra; Ratto, Carlo; Altomare, Donato F.; Ripetti, V.; Clerico, Giuseppe; Lise, M.; Doglietto, Giovanni Battista; Memeo, V.; Landolfi, V.; Genio, A. Del; Arullani, A; Giardiello, G.; Seta, Francesco De

doi:10.1007/bf02234782

Cited by 173 publications

(133 citation statements)

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“…10,11 The effect on sensation appears less clear; however, this research and other larger studies have suggested altered rectal sensation. 13 This paper reports the first attempt to examine the autonomic nerves directly and illustrated a rapidly reversible, dose-dependent effect up to a threshold of 1.0-V. This finding may have implications for the level of future therapeutic stimulation.…”

Section: Discussionmentioning

confidence: 82%

“…One showed an improvement in 2 of 8 patients, 12 the second showed a subjective improvement. 13 This led to the first world implants of a sacral nerve stimulator for intractable idiopathic constipation.…”

mentioning

confidence: 99%

“…15 There appears to be an effect on afferent sensory nerves with heightened sensation yet there is little effect on the intrinsic enteric neurones, the recto-anal inhibitory reflex being unaffected. 13 This, however, is a crude indicator of enteric nerve function, in a nervous system that has the proven ability to adapt and regenerate.…”

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confidence: 99%

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Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Kenefick

2006

annals

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INTRODUCTION Incontinence and constipation are common and cause a high degree of physical, social and psychological impairment. Maximal conservative therapy may improve some patients but many remain symptomatic. Surgical options are often unsatisfactory, with variable result and further options are limited. Sacral nerve stimulation uses electrical stimulation applied to the sacral nerves, eliciting a physiological effect on the lower bowel, anal sphincter and pelvic floor, resulting in clinical benefit. The objective of this study was to investigate whether sacral nerve neuromodulation can improve patients with disorders of bowel motility, when current maximal treatment has failed and to investigate the underlying physiological mechanism of action. RESULTSIncontinence: Nineteen patients, age 58 years (range, 37-71 years), with resistant incontinence for 6 years (range, 2-21 years) underwent stimulation. Continence improved in all at 24 months (range, 3-60 months), fourteen fully continent. Incontinent episodes decreased; 12 (range, 2-30) versus 0 (range, 0-4), P < 0.001. Urgency ( P < 0.01) and quality of life improved ( P < 0.05). Anal squeeze pressure ( P = 0.001) and rectal sensation ( P < 0.01) improved.Constipation: Four women, (aged 27-36 years) with resistant idiopathic constipation for 8-32 years underwent the first worldwide implants. Symptoms improved in all with temporary, and in three with permanent, stimulation at 8 months (range, 1-11 months). Bowel frequency increased: 1-5 versus 6-28 evacuations/3-weeks. Symptom scores and quality of life improved.Placebo effect: A double-blind, cross-over study was performed to examine placebo effect and efficacy. Once stimulation was removed, in a blinded manner, symptoms, physiological parameters and quality of life measures rapidly returned to baseline levels.Autonomic neuromodulation: Sixteen patients, median age 59 years (range, 38-71 years), were studied at 27 months (range, 2-62 years) using laser Doppler flowmetry. Chronic stimulation was at 2.8 V (range, 0.3-3.9 V). Median flux differed between none and chronic stimulation (P = 0.001).Step-wise increments caused an immediate, dose-dependent rise in flux ( P < 0.0001) up to 1.0 V. CONCLUSIONS This research provides strong evidence that sacral nerve stimulation can improve patients with resistant incontinence and shows proof-of-concept for the treatment of constipation. The effect is unlikely to be due to placebo and the mechanism is rapidly reversible and involves a dose-dependent effect on the autonomic nerves.

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Section: Discussionmentioning

confidence: 82%

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confidence: 99%

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Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Kenefick

2006

annals

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“…Failure to respond may be due to a number of factors such as lead displacement, genuine absence of response or neurological injury. SNS is not effective in patients with a high complete spinal cord transection [31]. Indeed, neurological integrity would seem to be a pre-requisite as the technique has not been used successfully in patients with complete pudendal nerve lesions [28, 31].…”

Section: Resultsmentioning

confidence: 99%

Sacral Nerve Stimulation for Faecal Incontinence

Pillinger¹,

Gardiner²,

Duthie³

2005

Dig Surg

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Faecal incontinence is a common problem. Conservative measures are effective in a significant proportion of patients. Failure of conservative management has until recently meant recourse to surgical intervention. Surgical treatment is often associated with disappointing results. Recently, sacral nerve stimulation (SNS) has been developed as a minimally invasive, effective technique for idiopathic and acquired faecal incontinence. The technique uses chronic low-level electrical stimulation of the sacral nerves, or neuromodulation, to produce a clinically beneficial effect on the distal colon and rectum, the pelvic floor and the anal sphincter complex. SNS is a 2-stage procedure: a diagnostic stage – temporary percutaneous nerve evaluation (PNE), and a therapeutic stage – permanent SNS. The predictive value of PNE is high, and the surgical trauma and morbidity of both procedures extremely low. The technique has been adapted from its original application in urinary dysfunction. It is almost impossible to produce level 1 evidence for this type of intervention; however, the results are superior to other interventions. Patient selection criteria are evolving, but there is a growing body of evidence that supports its use as first-line treatment for faecal incontinence in patients where conservative measures have failed.

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“…Sacral nerve stimulation (SNS) has been used since 1967 to activate bladder voiding (91,132,182,241), to treat bladder incontinence (20,34,44,59,78,108,119,120,122,221,229), to alleviate pelvic pain (1,38,190,279), to prevent fecal incontinence (50,(72)(73)(74)103,153), and to relieve constipation (56,128,133,134,161,166,167,186,189,248,252,272 (87,112,138,147,198,199,219) led to many devices (152,201) for improving walking (81,237), activating hand function (24) through voice commands (94), enhancing coughing (154), and even relieving seating pressures (65). Called neuroprostheses (25,193), these devices often are designed to correct specific deficits, such as foot drop (27,217,245) and hand grasp weakness (47,249,267).…”

Section: Peripheral Nerve Stimulationmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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Short-term sacral nerve stimulation for functional anorectal and urinary disturbances: Results in 40 patients

Abstract: In functional bowel disorders short-term sacral nerve stimulation seems to be a useful diagnostic tool to assess patients for a minor invasive therapy alternative to conventional surgical procedure.

Cited by 173 publications

References 11 publications

Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Sacral Nerve Neuromodulation for the Treatment of Lower Bowel Motility Disorders

Sacral Nerve Stimulation for Faecal Incontinence

Electrical Stimulation and Motor Recovery

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