16 research outputs found
The development and validation of tools to improve the efficacy of sacral neuromodulation and understanding of its action
Sacral neuromodulation : mechanism of action
Although the mechanism of action of sacral neuromodulation (SNM) is still not fully elucidated, it seems to involve modulation of spinal cord reflexes and brain networks by peripheral afferents according to findings from neurophysiology, electroencephalography, positron emission tomography, and magnetic resonance imaging studies. Moreover, motor effects mediated via efferents on direct stimulation cannot be fully excluded. In this mini-review, we summarize current knowledge on the mechanism of action of SNM. PATIENT SUMMARY: We reviewed the literature on the mechanism of action of sacral neuromodulation, in which electrical stimulation is applied to the nerves that regulate bladder activity. The mechanism seems to involve modulation of spinal cord reflexes and brain networks by peripheral sensory and possibly motor neurons
Needle placement and position of electrical stimulation inside sacral foramen determines pelvic floor electromyographic response-implications for sacral neuromodulation
Neuro-urology: functional disorders in male and female urogenital trac
Peak retrograde flow a potential objective management tool to identify young adults with varicocele 'at risk' for a high sperm DNA fragmentation
Evolution of testicular asymmetry during puberty in adolescents without and with a left varicocele
Detailed investigation of bladder diary parameters during sacral neuromodulation in patients with overactive symptoms
The influence of electrode configuration changes on the sensory and motor response during (re)programming in sacral neuromodulation
Sacral neuromodulation using the standardized tined lead implantation technique with a curved vs a straight stylet : 2\u2010year clinical outcomes and sensory responses to lead stimulation
Pelvic floor muscle electromyography as a guiding tool during lead placement and (re)programming in sacral neuromodulation patients : validity, reliability, and feasibility of the technique
Purpose To assess the validity, reliability, and feasibility of electromyography (EMG) as a tool to measure pelvic floor muscle (PFM) contractions during placement and (re)programming of the tined lead electrodes in sacral neuromodulation (SNM) patients. Materials and Methods Single tertiary center, prospective study conducted between 2017 and 2019 consisting of three protocols including a total of 75 patients with overactive bladder (wet/dry) or nonobstructive urinary retention. PFM EMG was recorded using the multiple array probe (MAPLe), placed intravaginally. All stimulations (monophasic pulsed square wave, 210 mu sec, 14 Hz) were performed using Medtronic's standard SNM stimulation equipment. During lead implantation, all four lead electrodes were stimulated with fixed increasing stimulation intensities (1-2-3-5-7-10 V). During lead electrode (re)programming, five bipolar lead electrode configurations were stimulated twice up to when an electrical PFM motor response (EPFMR), sensory response, and pain response were noted (i.e., the threshold), respectively. Additionally, amplitude and latency of the EPFMRs were determined. Validity, reliability, and feasibility were statistically analyzed using the intraclass correlation coefficient, weighted Cohen's kappa and linear regression, respectively. Results Validity: EPFMRs were strongly associated with visually detected PFM motor responses (kappa= 0.90). Reliability: EPFMR amplitude (ICC = 0.99) and latency (ICC = 0.93) showed excellent repeatability. Feasibility: linear regression (EPFMR threshold = 0.18 mA + 0.76 * sensory response threshold) showed an increase in the sensory response threshold is associated with a smaller increase in EPFMR threshold, with the EPFMR occurring before or on the sensory response threshold in 83.8% of all stimulations. Conclusions Measuring PFM contractions with EMG during placement and (re)programming of lead electrodes in SNM patients is valid, reliable, and feasible. Therefore, the use of PFM EMG motor responses could be considered as a tool to assist in these procedures.Neuro-urology: functional disorders in male and female urogenital trac