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Alghazwani Y, Alghafees MA, Alfraidi O, Aldarrab R. Sacral Neuromodulation in a Pregnant Patient With Fowler's Syndrome: A Case Report. Cureus 2020; 12:e11796. [PMID: 33409041 PMCID: PMC7779170 DOI: 10.7759/cureus.11796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fowler's syndrome (FS) is a condition in which females face chronic urinary retention with abnormal electromyography (EMG) findings in the absence of structural anomalies. A sacral neuromodulation (SNM) device that restores urinary discharge is often used for treatment. It is advised to turn the device off during pregnancy. This is a case report of a 37-year-old pregnant female suffering from FS. The patient was on SNM and underwent two uneventful pregnancies despite the device being kept on throughout both pregnancies. There were no complications, and a healthy term baby was born on both occasions.
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Roulette P, Castel-Lacanal E, Sanson S, Caremel R, Phé V, Bart S, Duchêne F, De Sèze M, Even A, Manunta A, Scheiber-Nogueira MC, Mouracade P, Loche CM, Chartier-Kastler E, Ruffion A, Karsenty G, Gamé X. Sacral neuromodulation and pregnancy: Results of a national survey carried out for the neuro-urology committee of the French Association of Urology (AFU). Neurourol Urodyn 2017; 37:792-798. [PMID: 29160571 DOI: 10.1002/nau.23349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/06/2017] [Indexed: 11/09/2022]
Abstract
AIMS To assess the impact of sacral neuromodulation (SNM) on pregnancy and vice-versa, by identifying women who had received SNM for lower-urinary tract symptoms (LUTS) and had become pregnant. METHODS A cross-sectional descriptive study was carried out based on responses to an on-line questionnaire sent to practitioners listed on the InterStim enCaptureTM National Registry. Questions were related to pre-pregnancy health and SNM efficacy, deactivation of the device, its impact on LUTS, childbirth, the infant, its reactivation and postpartum effectiveness. RESULTS Twenty-seven pregnancies were recorded among 21 women. Six women had had a pregnancy prior to implantation, two of whom had had a c-section. A total of 18.5% of women had the device disabled prior to conception. The others had their device disabled during the first trimester and did not reactivate it before delivery. Complications were reported in 25.9% of pregnancies: six women had urinary infections, including three of the four treated for chronic retention of urine (CRU), and 1 woman had pain at the stimulation site. There were 24 live births (including one premature birth and four c-sections), one spontaneous miscarriage and two voluntary interruptions of pregnancy. No neonatal disorders have been reported. Effectiveness of sacral neuromodulation decreased in 20% in postpartum. CONCLUSIONS In 27 pregnancies established during SNM for LUTS, 18.5% of patients deactivated their case before pregnancy and the others switched it off during the first trimester. Three-quarters of women with CRU had urinary infection. No adverse effects on fetuses were found. SNM effectiveness deteriorated in 20% cases after childbirth.
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Affiliation(s)
- Pauline Roulette
- Department of Urology, Andrology and Transplantation, CHU Rangueil, Toulouse, France
| | | | - Sylvain Sanson
- Department of Urology, Clinique du Pont de Chaume, Montauban, France
| | - Romain Caremel
- Clinique du Cèdre, Cèdre's Urology Center, Bois Guillaume, France
| | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Stéphane Bart
- Department of Urology, CH René-Dubos, Pontoise, France
| | - Franck Duchêne
- Clinique de l'Alliance, Department of Urology, Saint Cyr sur Loire, France
| | - Marianne De Sèze
- Clinique Saint Augustin, Neuro-Urology, Pelviperineology and Urodynamic Clinical Center, Bordeaux, France
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation, Hôpital Raymond-Poincaré AP-HP, Garches, France
| | - Andréa Manunta
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Pascal Mouracade
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - Catherine-Marie Loche
- Department of Physical Medicine and Rehabilitation, Assistance Publique des Hôpitaux de Paris, Henri Mondor Teaching Hospital, Créteil, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Alain Ruffion
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Xavier Gamé
- Department of Urology, Andrology and Transplantation, CHU Rangueil, Toulouse, France
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The effect of sacral neuromodulation on pregnancy: a systematic review. Int Urogynecol J 2017; 28:1357-1365. [PMID: 28160010 DOI: 10.1007/s00192-017-3272-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/08/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate the effects of sacral neuromodulation (SNM) on pregnancy and the impact of delivery on SNM function. METHODS A systematic search was conducted through January 2016. We selected studies including women who had SNM and a subsequent pregnancy. RESULTS Out of 2,316, eight studies were included, comprising 22 patients (26 pregnancies). SNM indications were Fowler's syndrome in 11, urinary retention in 6, fecal incontinence in 1, fecal and urinary urgency in 1, overactive bladder in 1, intractable interstitial cystitis in 1, and myelodysplasia in 1. SNM stayed on in 8 pregnancies. In the remaining 18 pregnancies in which the device was deactivated, 7 had recurrent urinary tract infections, including 1 with pyelonephritis and 2 who requested reactivation owing to recurrent symptoms. Outcomes were reported in 25 pregnancies, 16 had Cesarean section (CS) and 9 had vaginal delivery, including 2 operative deliveries. Out of 25, two infants had pilonidal sinus and motor tic disorder (exhibited at the age of 2 years), both from the same mother. After delivery, SNM was functioning in 15 (60%), 4 required reprogramming, and 3 required replacement (1 had recurrence of fecal incontinence after her operative delivery with evidence of displaced leads and 1 patient reported decreased SNM effects after her two CS), and 3 decided to remove the device (2 out of 3 patients were free of symptoms after SNM deactivation and requested removal). CONCLUSION Within the current limited evidence, the decision regarding SNM activation or deactivation should be individualized. A registry for those patients is recommended.
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Yaiesh SM, Al-Terki AE, Al-Shaiji TF. Safety of Sacral Nerve Stimulation in Pregnancy: A Literature Review. Neuromodulation 2016; 19:770-779. [DOI: 10.1111/ner.12450] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/27/2016] [Accepted: 04/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Said M. Yaiesh
- Ministry of Health, Al Amiri Hospital; Kuwait City Kuwait
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Abstract
BACKGROUND Unilateral posterior tibial nerve stimulation has been shown to improve fecal incontinence in the short term. Posterior tibial nerve stimulation is believed to work by stimulation of the ascending afferent spinal pathways. Bilateral stimulation may activate more of these pathways. This may lead to an improved therapeutic effect. OBJECTIVE The aim of this study was to assess the efficacy of bilateral transcutaneous posterior tibial nerve stimulation for fecal incontinence. DESIGN This was a single-group pilot prospective study. SETTING The study was conducted from June 2012 to September 2012 at the authors' institution. PATIENTS Twenty patients with fecal incontinence were recruited consecutively. Conservative therapy had failed to improve the fecal incontinence in all 20 patients. INTERVENTION All patients received 30 minutes of daily bilateral stimulation for 6 weeks. The bilateral stimulation was administered by each patient at home. No further stimulation was given after 6 weeks, and the patients were followed up until their symptoms returned to the prestimulation state (baseline). MAIN OUTCOME MEASURE The primary outcome measure was a change in the frequency of incontinent episodes per week. RESULTS Seventeen patients completed 6 weeks of treatment. Two patients achieved complete continence. Ten (59%) achieved a ≥50% reduction in frequency of incontinent episodes. Overall, there was a significant reduction in median (interquartile range) frequency of incontinent episodes per week of 6 (8.25) to 2 (7.25) (p = 0.03). There was a significant improvement in the ability to defer defecation from 3 (4) to 5 (8) minutes (p = 0.03). There was no change in the St Mark's incontinence score. One domain of the Rockwood fecal incontinence quality-of-life score and of the Medical Outcomes Study Short Form 36 score improved significantly. LIMITATIONS This study was limited by its small size and its lack of blinding and control. CONCLUSIONS Bilateral transcutaneous posterior tibial nerve stimulation appears to be a cheap and effective treatment for fecal incontinence. It can easily be used by the patient at home.
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