1
|
Kim J, So B, Heo Y, So H, Jo JK. Penile Erection Morphometry: The Need for a Novel Approach. World J Mens Health 2024; 42:667-680. [PMID: 38164024 PMCID: PMC11439814 DOI: 10.5534/wjmh.230179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 01/03/2024] Open
Abstract
For many males, sexual function holds significant value in determining their quality of life. Despite the importance of male erectile function, no quantitative method to measure it accurately is currently available. Standardized assessment methods such as RigiScan™, International Index of Erectile Function (IIEF-5), and the stamp test are used to evaluate sexual function, but those methods cannot repetitively and quantitatively measure erectile function. Only direct measurement can quantitatively assess the shape of an erect penis. This paper presents the essential requirements for developing an ideal measurement method for penile erection. It also introduces current approaches for diagnosing male sexual function and reviews ongoing research to quantitatively measure erectile function. The paper further summarizes and analyzes the advantages and disadvantages of each method with respect to the essential requirements. Finally, the paper discusses the future direction toward the development of Penile Erection Morphometry.
Collapse
Affiliation(s)
- Jongwon Kim
- Department of Medical and Digital Engineering, Hanyang University, Seoul, Korea
| | - Byeongchan So
- Department of Medical and Digital Engineering, Hanyang University, Seoul, Korea
| | - Yongki Heo
- Department of Medical and Digital Engineering, Hanyang University, Seoul, Korea
| | - Hongyun So
- Department of Medical and Digital Engineering, Hanyang University, Seoul, Korea
- Institute of Nano Science and Technology, Hanyang University, Seoul, Korea
- Department of Mechanical Engineering, Hanyang University, Seoul, Korea.
| | - Jung Ki Jo
- Department of Medical and Digital Engineering, Hanyang University, Seoul, Korea
- Department of Urology, College of Medicine, Hanyang University, Seoul, Korea.
| |
Collapse
|
2
|
Maciaczyk J, Bara G, Kurth F. [Functional-neurosurgical treatment options for functional pelvic floor disorders : Value of sacral neuromodulation]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:835-843. [PMID: 37823893 DOI: 10.1007/s00117-023-01214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Sacral neuromodulation is an established minimally invasive therapy indicated for the treatment of functional pelvic floor disorders. While it received its original US Food and Drug Administration (FDA) approval for the treatment of overactive bladder symptoms, it is now regarded as a therapeutic option to treat both urinary/fecal incontinence and retention. In addition, it has proven to be a valuable tool in the treatment of chronic pelvic pain, and preliminary results indicate a potential to elicit improvements in sexual functioning. OBJECTIVE This article serves to provide a summary of the therapy and its applications. METHOD Selective literature review. RESULTS Sacral neuromodulation implants allow for the controlled shifting of the autonomic control of bladder and rectum towards an inhibition or facilitation of voiding, dependent on the patient's needs and under the patient's control. At the same time and depending on the applied stimulation, the implants can interfere with the nerve's conduction of pain signals. This makes them a therapeutic option for pelvic pain that fails to respond to conventional treatment. Finally, there have been first reports suggesting improvements in sexual dysfunction under sacral neuromodulation, thus, potentially opening up a new line of therapy for those disorders. DISCUSSION Sacral neuromodulation is a flexible and efficient form of therapy for functional disorders of the pelvic floor. Specifically, the same intervention can treat seemingly contradictory disorders such as urinary/fecal incontinence and retention as well as chronic pain.
Collapse
Affiliation(s)
- Jarek Maciaczyk
- Abteilung Stereotaktische und Funktionelle Neurochirurgie, Klinik für Neurochirurgie, Uniklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Gregor Bara
- Abteilung Stereotaktische und Funktionelle Neurochirurgie, Klinik für Neurochirurgie, Uniklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Florian Kurth
- Abteilung Stereotaktische und Funktionelle Neurochirurgie, Klinik für Neurochirurgie, Uniklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| |
Collapse
|
3
|
Cedergren Weber G, Odin P. Diagnostic work up: Laboratory and biomarkers. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 162:53-96. [PMID: 35397789 DOI: 10.1016/bs.irn.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This chapter will focus on the diagnostic work around sexual dysfunction in Parkinson's disease, especially laboratory tests and biomarkers. A number of methods to analyze if sexual dysfunction is caused by neural pathology, vascular dysfunction or other mechanisms are now available. Other methods can be used to differentiate between psychogenic/functional reasons behind sexual dysfunction and organic ones. The role of biomarkers for diagnosis, but also for understanding the reason behind and for counteracting sexual dysfunction is becoming more evident. There is also a rich and increasing number of scales and other instruments available for detecting and quantifying sexual hypo- and hyperactivity. When investigating the reason behind sexual dysfunction in patients with Parkinson's disease comorbidities should also be considered. Finally, early and pronounced sexual dysfunction might in some cases be an indication that differential diagnosis, like Multisystem Atrophy, should be thought about. All these aspects of the diagnostic procedures around sexual dysfunction in Parkinson's disease will be covered in this chapter.
Collapse
Affiliation(s)
- Gustav Cedergren Weber
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
4
|
Bakrim N, Chabannes É, Detree P, Balssa L, Wagner L, Kleinclauss F. [Sacral neuromodulation as treatment of non-neurological vesical emptying disorders]. Prog Urol 2021; 32:14-22. [PMID: 34332832 DOI: 10.1016/j.purol.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
GOAL The goal was to evaluate the results of sacral neuromodulation (SNM) in non-neurological vesical emptying disorders. PATIENTS AND METHODS From February 2010 to October 2017, 28 patients presenting voiding symptoms or a non-obstructive chronic urine retention without neurological cause have been operated for an SNM (test phase). The test was positive in case of decreased number of proper intermittent self-catheterization (SC) or post-voiding residual urine (PVR) of at least 50 %. A 100 % positive result meant the return to a spontaneous voiding without SC with a non-significative PVR (<100ml). RESULTS The median follow-up was of 53.2±21.2 months. Twenty-four (85.7%) tests were positive, from which twenty-two (78.6%) were 100% positive. 16 (84.2%) out of 19 patients with SC had spontaneous voiding without PVR. The number of daily SC decreased from 4.6±1.5 to 0.4±1.2 in post-operative (P<0.001). The PVR was of 287.1±170.4ml vs. 30.4±48.6ml in post-operative (P<0.001). Fourteen patients (58.3%) underwent at least one chirurgical revision or a removal of material ; mainly for loss of efficiency, end of battery, electrode migration and pain on material. At the end of the follow-up, 70.8% of the responding patients had their device still efficient. CONCLUSION Results showed that SNM appears to be an efficient treatment of non-neurological emptying vesical troubles. Nevertheless, the re-operation rate was still significant. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- N Bakrim
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France; Université de Franche Comte, Besançon, France.
| | - É Chabannes
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - P Detree
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - L Balssa
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - L Wagner
- Service d'urologie andrologie, CHU Caremeau, Nîmes, France
| | - F Kleinclauss
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France; Université de Franche Comte, Besançon, France; Nanomedicine Lab, Imagery and Therapeutics", EA 4662, Besancon, France
| |
Collapse
|
5
|
Abd-Elsayed A, Mitry C, Mitry J, Nadherny W. Anesthetic Considerations and Perioperative Management of Sacral Neuromodulators: Literature Review and Initial Recommendations. Neuromodulation 2020; 23:1117-1120. [DOI: 10.1111/ner.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/14/2020] [Indexed: 09/02/2023]
|
6
|
Del Popolo G, Cito G, Gemma L, Natali A. Neurogenic Sexual Dysfunction Treatment: A Systematic Review. Eur Urol Focus 2020; 6:868-876. [DOI: 10.1016/j.euf.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/11/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022]
|
7
|
Afferi L, Pannek J, Louis Burnett A, Razaname C, Tzanoulinou S, Bobela W, da Silva RAF, Sturny M, Stergiopulos N, Cornelius J, Moschini M, Iselin C, Salonia A, Mattei A, Mordasini L. Performance and safety of treatment options for erectile dysfunction in patients with spinal cord injury: A review of the literature. Andrology 2020; 8:1660-1673. [PMID: 32741129 DOI: 10.1111/andr.12878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND For a large proportion of patients with spinal cord injury, sexuality and reproduction are important issues. However, sparse data exist regarding available treatment options for this patient population. OBJECTIVES We sought to review performance and safety rates of all currently available treatment options for erectile dysfunction in spinal cord injury men. MATERIALS AND METHODS A systematic literature review without time restrictions was performed using PubMed/EMBASE database for English-, Italian-, German-, and Spanish-language articles. Articles' selection was performed according to the PRISMA guidelines. Relevant papers on erectile dysfunction in spinal cord injury patients were included in the final analyses. RESULTS AND DISCUSSION Overall, 47 studies were eligible for inclusion in this review. Of these, most evidence dealt with phosphodiesterase 5-inhibitors and intracavernous drug injection. Both treatment options are associated with high levels of performance and with patients/partners' satisfaction; side effects are acceptable. Overall, penile prostheses and vacuum erection devices are in general less approved by spinal cord injury patients and are correlated with increased rates of complications in comparison with phosphodiesterase 5-inhibitors and intracavernous drug injection. Sacral neuromodulation, transcutaneous electrical nerve stimulation, and intraurethral suppositories have been poorly studied, but preliminary studies did not show convincing results. CONCLUSION The best treatment options for erectile dysfunction in spinal cord injury patients emerged to be phosphodiesterase 5-inhibitors and intracavernous drug injection. The choice of erectile dysfunction treatment should be based on several aspects, including residual erectile function, spinal cord injury location, and patients' comorbidities. Future studies assessing the applicability of less well-studied treatments, as well as evaluating innovative options, are needed in this specific population.
Collapse
Affiliation(s)
- Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Schweizer Paraplegiker Zentrum, Nottwil, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arthur Louis Burnett
- Department of Urology, John Hopkins Hospital, Brady Urological Institute, Baltimore, MA, USA
| | | | | | | | | | - Mikael Sturny
- Comphya SA, EPFL Innovation Park, Lausanne, Switzerland
| | | | - Julian Cornelius
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christophe Iselin
- Division of Urology, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| |
Collapse
|
8
|
Girtner F, Burger M, Mayr R. [Sacral neuromodulation in under- and overactive detrusor-quo vadis? : Principles and developments]. Urologe A 2019; 58:634-639. [PMID: 31139864 DOI: 10.1007/s00120-019-0949-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sacral neuromodulation (SNM) has been used in the treatment of refractory overactive bladder syndrome, nonobstructive urinary retention and faecal incontinence for almost 40 years now. It is not to be confused with the sacral anterior root stimulation which is exclusively used for bladder dysfunction due to spinal paraplegia. MECHANISM OF ACTION The principles of SNM are yet to be fully understood. Nevertheless, there is proof of modulating the activity of several micturition-associated, afferent neurons in the spine, brainstem and cerebrum. Thus, premature detrusor contractions are suppressed, the desire to void is delayed and detrusor-sphincter coordination improves. TECHNIQUES OF IMPLANTATION AND STIMULATION Motor reactions are an important indicator of correct electrode placement. The implantation procedure consists of two stages with an initial trial phase to determine the best possible treatment response through an external generator before implanting the whole stimulating device. Yearly check-up examinations are recommended; wireless adjustments allow for long-lasting symptom reduction. INDICATION AND OUTCOME Success rates in the treatment of the refractory overactive bladder syndrome and the non-obstructive urinary retention lie above 70% and can still be perceived as sufficient after 5 years of ongoing SNM therapy. There is also profound evidence of SNM being an effective option for patients with faecal incontinence or chronic obstipation. CONTRAINDICATIONS AND RISKS Children, pregnant women and patients in need of frequent MRI examinations are usually not eligible for SNM therapy. Infection of the implant, technical failure (including lead displacement and battery depletion) and pain in the implantation site are important adverse effects which might require surgical revision. CONCLUSIONS The indications for SNM in the German health care system can be expected to be expanded upon the chronic pelvic pain syndrome, erectile dysfunction and additional gastrointestinal conditions. Technical progress will continue to improve the risk-benefit ratio of SNM.
Collapse
Affiliation(s)
- F Girtner
- Klinik für Urologie am Caritas Krankenhaus St. Josef, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - M Burger
- Klinik für Urologie am Caritas Krankenhaus St. Josef, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland
| | - R Mayr
- Klinik für Urologie am Caritas Krankenhaus St. Josef, Universität Regensburg, Landshuter Straße 65, 93053, Regensburg, Deutschland.
| |
Collapse
|
9
|
Introduction. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.02021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
10
|
Apostolidis A, Rantell A, Anding R, Kirschner-Hermanns R, Cardozo L. How does lower urinary tract dysfunction (LUTD) affect sexual function in men and women? ICI-RS 2015-Part 2. Neurourol Urodyn 2017; 36:869-875. [DOI: 10.1002/nau.23088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/20/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Angie Rantell
- Department of Urogynaecology; King's College Hospital; London UK
| | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | | | - Linda Cardozo
- Department of Urogynaecology; King's College Hospital; London UK
| |
Collapse
|
11
|
Steadman CJ, Hubscher CH. Sexual Function after Spinal Cord Injury: Innervation, Assessment, and Treatment. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0067-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
12
|
Lombardi G, Musco S, Wyndaele JJ, Del Popolo G. Treatments for erectile dysfunction in spinal cord patients: alternatives to phosphodiesterase type 5 inhibitors? A review study. Spinal Cord 2015; 53:849-54. [DOI: 10.1038/sc.2015.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/12/2015] [Accepted: 06/01/2015] [Indexed: 11/09/2022]
|
13
|
Lombardi G, Musco S, Kessler TM, Marzi VL, Lanciotti M, Del Popolo G. Management of sexual dysfunction due to central nervous system disorders: a systematic review. BJU Int 2015; 115 Suppl 6:47-56. [DOI: 10.1111/bju.13055] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Giuseppe Lombardi
- Neuro-Urology Department; Careggi University Hospital; Florence Italy
| | - Stefania Musco
- Neuro-Urology Department; Careggi University Hospital; Florence Italy
| | - Thomas M. Kessler
- Neuro-Urology; Spinal Cord Injury Center and Research; Balgrist University Hospital; University of Zürich; Zürich Switzerland
| | | | | | - Giulio Del Popolo
- Neuro-Urology Department; Careggi University Hospital; Florence Italy
| |
Collapse
|
14
|
|
15
|
Basto CS, Herrera JMS, Gracia LNR, González YJCA. Neuromodulación en aneyaculación. Reporte de caso revisión de la literatura. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
16
|
Glina S, Glina FPA. Pathogenic mechanisms linking benign prostatic hyperplasia, lower urinary tract symptoms and erectile dysfunction. Ther Adv Urol 2013; 5:211-8. [PMID: 23904860 DOI: 10.1177/1756287213488236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) are clinical entities very prevalent in men aged over 50 years. There is evidence that both may have a common pathophysiology. OBJECTIVE The objective of this study was to conduct a literature review aiming to show theories and hypotheses that justify a single pathophysiology for ED and LUTS/BPH. METHODS A search in Medline using the keywords of the Medical Subject Headings (MESH) 'erectile dysfunction' and 'lower urinary tract symptoms' in all fields of the database up to 15 December 2012. This search found 198 relevant articles that were analyzed. RESULTS The data and articles were divided according to the type of evidence found. There are strong epidemiological data showing that LUTS/BPH is a risk factor for developing ED. Several experimental models demonstrated partial obstruction of the bladder in animals causes voiding disorders as well as a negative impact on erectile function of the operated animals. The increased adrenergic tonus in animals leads to prostate growth and urodynamic conditions similar to those found in men with LUTS and ED. Arteriosclerosis may lead to loss of vesical complacency, urinary tract obstruction and fibrosis of the cavernous bodies. The use of phosphodiesterase type 5 inhibitors (PDE-5i) and/or alpha-adrenergic blockers to treat ED and LUTS/BPH reinforces the hypothesis that, at least in some patients, both clinical pictures may have the same pathophysiology.
Collapse
Affiliation(s)
- Sidney Glina
- Instituto H.Ellis, Rua Cincinato Braga, 37 cj 102, Sao Paulo, 01333-011, Brazil
| | | |
Collapse
|
17
|
Surgical access for electrical stimulation of the pudendal and dorsal genital nerves in the overactive bladder: a review. J Urol 2011; 186:798-804. [PMID: 21788054 DOI: 10.1016/j.juro.2011.02.2696] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE The anatomy of the pudendal nerve and its nerve branches, especially the dorsal nerve of the penis and clitoris (dorsal genital nerves), and the clinical application of electrical stimulation of these nerves in patients with overactive bladder syndrome and detrusor overactivity are reviewed. MATERIALS AND METHODS A literature search was performed using the PubMed® database and reference lists of relevant studies to obtain articles concerning the anatomy as well as the electrical stimulation of the pudendal nerve and its nerve branches in patients with overactive bladder syndrome. RESULTS According to the anatomy, electrical stimulation of the pudendal nerve and the dorsal genital nerves to suppress involuntary detrusor contractions is possible at several sites along their course from the sacral nerves to the penis or clitoris. The nerves are accessible by minimally invasive percutaneous methods. Stimulation of the pudendal nerve and dorsal genital nerves effectively increases bladder capacity, and inhibits involuntary detrusor contractions and overactive bladder symptoms. CONCLUSIONS More clinically applied studies are recommended for stimulation of the dorsal genital nerves to assess its value and feasibility because most studies have been performed in an acute and experimental setting. The preferred type of electrode is not known, but if wire electrodes can be implanted and fixated well by a minimally invasive procedure, cuff electrodes are not necessary. Before deciding on continuous or conditional stimulation, chronic clinical studies are recommended because acute studies remain inconclusive. The feasibility of conditional stimulation depends on the availability of a reliable and clinically applicable detrusor activity sensor.
Collapse
|
18
|
Alsaid B, Moszkowicz D, Peschaud F, Bessede T, Zaitouna M, Karam I, Droupy S, Benoit G. Autonomic-somatic communications in the human pelvis: computer-assisted anatomic dissection in male and female fetuses. J Anat 2011; 219:565-73. [PMID: 21781094 DOI: 10.1111/j.1469-7580.2011.01416.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sphincter continence and sexual function require co-ordinated activity of autonomic and somatic neural pathways, which communicate at several levels in the human pelvis. However, classical dissection approaches are only of limited value for the determination and examination of thin nerve fibres belonging to autonomic supralevator and somatic infralevator pathways. In this study, we aimed to identify the location and nature of communications between these two pathways by combining specific neuronal immunohistochemical staining and three-dimensional reconstruction imaging. We studied 14 normal human fetal pelvic specimens (seven male and seven female, 15-31 weeks' gestation) by three-dimensional computer-assisted anatomic dissection (CAAD) with neural, nitrergic and myelin sheath markers. We determined the precise location and distribution of both the supra- and infralevator neural pathways, for which we provide a three-dimensional presentation. We found that the two pathways crossed each other distally in an X-shaped area in two spatial planes. They yielded dual innervation to five targets: the anal sphincter, levator ani muscles, urethral sphincter, corpus spongiosum and perineal muscles, and corpora cavernosa. The two pathways communicated at three levels: proximal supralevator, intermediary intralevator and distal infralevator. The dorsal penis/clitoris nerve (DN) had segmental nitrergic activity. The proximal DN was nNOS-negative, whereas the distal DN was nNOS-positive. Distal communication was found to involve interaction of the autonomic nitrergic cavernous nerves with somatic nitrergic branches of the DN, with nitrergic activity carried in the distal part of the nerve. In conclusion, the pelvic structures responsible for sphincter continence and sexual function receive dual innervation from the autonomic supralevator and the somatic infralevator pathways. These two pathways displayed proximal, intermediate and distal communication. The distal communication between the CN and branches of the DN extended nitrergic activity to the distal part of the cavernous bodies in fetuses of both sexes. These structures are important for erectile function, and care should therefore be taken to conserve this communication during reconstructive surgery.
Collapse
Affiliation(s)
- Bayan Alsaid
- Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, University of Paris-Sud 11, Le Kremlin-Bicêtre, France.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
AIM The aim of this article was to determine the effect of sacral nerve stimulation (SNS) on the treatment of faecal incontinence, constipation, irritable bowel syndrome, mixed urinary and bowel disorders, spinal injury and neurodegenerative disease, pain syndromes, and sexual dysfunction. METHOD A Medline search was performed including the keywords and/or MeSH headings of 'sacral nerve stimulation', 'neuromodulation', 'artificial pacemaker', 'faecal incontinence', 'constipation' and 'anal pain'. Further studies were identified by cross-referencing from relevant articles and by appraisal of recent peer-reviewed conference abstracts and proceedings. RESULTS SNS has been used for the treatment of urinary, bowel and sexual dysfunction, as well as pain resulting from such disorders, and dysfunction arising from nerve injury and degenerative disease. There is a paucity of high quality evidence to support the use of SNS for the majority of novel indications at present. CONCLUSION Good quality prospective, cross-over studies are required to determine the true benefits of SNS. Further research into patient selection, operative technique and stimulation parameters for existing indications will ensure a place for SNS in the future treatment algorithm of functional pelvic floor disorders.
Collapse
Affiliation(s)
- T C Dudding
- Basingstoke and North Hampshire Hospital, Basingstoke, UK.
| |
Collapse
|
20
|
Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury. Spinal Cord 2011; 49:629-36. [PMID: 21283086 DOI: 10.1038/sc.2010.176] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the concomitant clinical improvement in incomplete spinal cord injury patients (SCIPs) suffering from neurogenic bowel symptoms (NBSs), neurogenic lower urinary tract symptoms (NLUTSs) and neurogenic erectile dysfunction (NED) using sacral neuromodulation (SNM) for NBSs and NLUTSs. METHODS Seventy-five SCIPs were selected. Before and during the follow-ups post-SNM, NLUTSs and NBSs were detected mainly through specific diaries. Erectile function was assessed using the International Index of Erectile Function composed of 5 questions (IIEF5). Quality of life (QoL) was measured with the Short Form 36 Health Survey questionnaire (SF-36). During the first stage, in which a permanent electrode was inserted percutaneously into the third sacral foramina and stimulated using an external generator, patients with NBSs or NLUTSs were required to improve their symptoms by at least 50% compared with baseline before proceeding to the second stage in which the generator was placed in the patient's buttock. NED patients needed to increase their IIEF5 score by at least 25% compared with baseline (evaluated initially 3 months after the second stage) in order to continue follow-up. RESULTS Fourteen out of 37 subjects who manifested two functional pelvic dysfunctions at baseline maintained notable clinical improvement in two pelvic functions (median follow-up >3 years). Six had non-obstructive retention (NOR) and NED, six double incontinence, and two constipation with NOR. In the general and mental health domains of the SF-36, all patients improved their scores by at least 20% compared with baseline. CONCLUSIONS SNM may be beneficial to selected incomplete SCIP with concomitant pelvic functional disturbances.
Collapse
|
21
|
Abstract
This article represents a general overview of therapies for urinary urgency, frequency, and overactive bladder, with specific emphasis on sacral neuromodulation. The history of sacral neuromodulation is discussed along with an update of the current literature. Future directions for neuromodulation of the pelvic floor also are discussed.
Collapse
Affiliation(s)
- John A Occhino
- Division of Gynecologic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | | |
Collapse
|
22
|
Kessler TM, La Framboise D, Trelle S, Fowler CJ, Kiss G, Pannek J, Schurch B, Sievert KD, Engeler DS. Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction: Systematic Review and Meta-analysis. Eur Urol 2010; 58:865-74. [PMID: 20934242 DOI: 10.1016/j.eururo.2010.09.024] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/06/2010] [Indexed: 12/17/2022]
|
23
|
Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J 2010; 21:1553-8. [DOI: 10.1007/s00192-010-1281-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
24
|
|
25
|
Le point sur les traitements de seconde ligne de l’hyperactivité vésicale idiopathique. Prog Urol 2009; 19:530-7. [DOI: 10.1016/j.purol.2009.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 01/29/2009] [Accepted: 02/02/2009] [Indexed: 11/18/2022]
|
26
|
Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions. Spinal Cord 2009; 48:154-9. [PMID: 19668257 DOI: 10.1038/sc.2009.101] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Efficacy and safety of sacral neuromodulation (SNM) in incomplete spinal cord-injured patients (SCIPs) affected by chronic neurogenic bowel symptoms (NBSs). SETTING Neurourology Department. Primary to tertiary care. METHODS Retrospective non-blinded study without controls. Thirty-nine SCIPs were submitted to temporary stimulation for NBS. Permanent implantation was carried out if both their NBSs improved and the Wexner questionnaire scores were reduced by at least 50% during the first stage compared with that at baseline. Outcome measures included episodes of fecal incontinence and number of evacuations per week, as well as the Wexner score and the Short Form 36 (SF-36) Health Survey questionnaire. RESULTS Twenty-three SCIPs were submitted to definitive SNM, maintaining their clinical benefits after permanent implantation with a median follow-up of 38 months. The length of time since neurological diagnosis to SNM therapy represents the only factor related to the success of the implantation, P<0.05. In subjects with constipation (12), the median number of evacuations shifted from 1.65 to 4.98 per week, whereas the Wexner score changed from 19.91 to 6.82 in the final checkup with P<0.05. In subjects with fecal incontinence (11), the median number of episodes per week in the final follow-up was 1.32 compared with 4.55 pre-SNM. The general and mental health of both groups was measured with the SF-36 questionnaire and consistently showed statistical improvement (P<0.05).Anorectal manometry showed no important variation compared with baseline. There were no major complications. CONCLUSIONS SNM therapy should be considered for the treatment of NBS for select patients with incomplete spinal cord injury when conservative treatments fail.
Collapse
|
27
|
Current World Literature. Curr Opin Obstet Gynecol 2009; 21:353-63. [DOI: 10.1097/gco.0b013e32832f731f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Lee YC, Wu WJ, Liu CC, Wang CJ, Li WM, Huang CH, Yeh HC, Ke HL, Huang SP. The associations among eNOS G894T gene polymorphism, erectile dysfunction, and benign prostate hyperplasia-related lower urinary tract symptoms. J Sex Med 2009; 6:3158-65. [PMID: 19515207 DOI: 10.1111/j.1743-6109.2009.01353.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION A number of literature has now identified the role of impaired nitric oxide synthase/nitric oxide pathway in the endothelium as the central to the development of erectile dysfunction (ED) and benign prostate hyperplasia-related lower urinary tract symptoms (BPH/LUTS). Recently a few studies have reported the associations between endothelial nitric oxide synthase (eNOS) G894T gene polymorphisms and ED. However, there has been no report investigating the eNOS G894T genetic susceptibility factor for both ED and BPH/LUTS. AIM To investigate the possible associations among eNOS G894T polymorphism, ED, and BPH/LUTS in a Taiwanese population. MAIN OUTCOME MEASURES Patients with ED were defined as those having a 5-item International Index of Erectile Function-5 <21. METHODS In all, 372 Taiwanese men underwent a free health screening were enrolled. All the men had complete clinical data and questionnaires taken. The eNOS G894T polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism method. RESULTS Three hundred seventy-two men had a mean (standard deviation) age of 60.2 (8.8) years. With multivariate analysis, our data identified that aging, diabetes mellitus (DM), and eNOS G894T gene polymorphism were three independent common risk factors for both ED and BPH/LUTS (P < 0.001, P = 0.036, and P = 0.039 for ED; P = 0.034, P = 0.004, and P = 0.016 for BPH/LUTS, respectively). The eNOS 894T allele carriers had significantly higher prevalence of ED (77.9% vs. 60.4%, P = 0.012) and higher International Prostate Symptom score (IPSS) (13.3 +/- 10.7 vs. 9.3 +/- 7.8, P = 0.001) than G allele carriers. CONCLUSIONS Our results showed that aging, DM, and eNOS 894T allele carrier gene polymorphism were the three independently common risk factors for both ED and BPH/LUTS in the Taiwanese population. The eNOS 894T allele carriers had significantly higher frequencies of ED and higher IPSS, suggesting that eNOS G894T gene polymorphisms may play an implication as a genetic susceptibility factor for both ED and BPH/LUTS.
Collapse
Affiliation(s)
- Yung-Chin Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|