Sacral nerve stimulation lead implantation in partial sacral agenesis using intra-operative computerized tomography

Analysis of clinical efficacy of sacral magnetic stimulation for the treatment of detrusor underactivity

Objective

The objective of this study was to investigate the effectiveness and safety of sacral magnetic stimulation (SMS) in the management of detrusor underactivity (DU).

Methods

We retrospectively analyzed 66 patients with detrusor underactivity treated at Hangzhou Third People's Hospital from January 2020 to October 2024, divided into two groups (33 cases each). Both groups had confirmed detrusor underactivity via urodynamic studies. The control group received conventional treatment (medication, catheterization, bladder training), while the observation group received SMS therapy. Urination diaries, urodynamic parameters and self-rating anxiety scale (SAS) were collected before and after the 4-week treatment to evaluate SMS efficacy and safety.

Results

All patients in the observation group completed the course of sacral magnetic stimulation without experiencing any serious complications. After treatment, the observation group showed a significant reduction in the number of daily urinations, nocturnal urinations, SAS score and residual urine volume (RUV) (p < 0.05) compared with the control group. There was no statistically significant difference in maximum cystometric capacity (MCC) (p > 0.05). However, improvements were observed in SAS score, Detrusor Pressure at Maximum Flow (Pdet), Bladder Contractility Index (BCI), Maximum urinary Flow Rate (Qmax) and Average Urinary Flow Rate (Qavg) (p < 0.05). The effective rate in the observation group was 78.78%, significantly higher than that in the control group (p < 0.05). Although there was a slight decrease in the effective rate during the 6-month follow-up, the difference was not statistically significant (p > 0.05).

Conclusion

In conclusion, sacral magnetic stimulation therapy has demonstrated effectiveness in improving urinary function in patients with detrusor underactivity while maintaining a high level of safety.

Effectiveness of sacral neuromodulation with 3D printing and ultrasound localization for treating neurogenic bladder in patients with pelvic structural anomalies

OBJECTIVE

To assess the efficacy and safety of Sacral Neuromodulation (SNM) in conjunction with 3D printing and ultrasound localization for treating patients with neurogenic bladder and pelvic structural anomalies.

METHODS

This prospective study involved 56 patients diagnosed with neurogenic bladder and pelvic anomalies. They were treated with SNM from January 2022 to December 2023. Patients were split into study and control groups based on the origins of their pelvic anomalies, with each group comprising 28 individuals. The study group underwent preoperative 3D printing and intraoperative ultrasound-assisted puncture, whereas the control group utilized intraoperative X-ray-assisted puncture. Metrics compared included the number of punctures, average puncture duration, intraoperative SNS tuning time, effective initial voltage, postoperative testing duration, phase two conversion rates, and the incidence of bleeding and infection.

RESULTS

The study group experienced significantly fewer punctures compared to the control group (2.21 ± 0.92 vs 9.29 ± 4.37) (P < 0.01), had a shorter average puncture duration (5.71 ± 2.69 min vs. 28.60 ± 9.69 min) (P < 0.01), and required a lower effective initial voltage (0.87 ± 0.23v vs. 1.38 ± 0.52v) (P < 0.01). X-ray exposure was eliminated in the study group, in contrast to 11.51 ± 4.62 mAs in the control group(P < 0.01). The phase two implantation rates were 67.8 % for the study group and 57.1 % for the control group(P = 0.04). No surgery-related complications occurred in either group.

CONCLUSION

Combining preoperative 3D printing with intraoperative ultrasound-assisted puncture significantly improves the accuracy of SNM placement, reduces surgery time, and eliminates X-ray exposure for both doctors and patients. This method is both safe and effective for patients with neurogenic bladder and pelvic anomalies.

Baiona's Consensus Statement for Fecal Incontinence. Spanish Association of Coloproctology

Faecal incontinence (FI) is a major health problem, both for individuals and for health systems. It is obvious that, for all these reasons, there is widespread concern for healing it or, at least, reducing as far as possible its numerous undesirable effects, in addition to the high costs it entails. There are different criteria for the diagnostic tests to be carried out and the same applies to the most appropriate treatment, among the numerous options that have proliferated in recent years, not always based on rigorous scientific evidence. For this reason, the Spanish Association of Coloproctology (AECP) proposed to draw up a consensus to serve as a guide for all health professionals interested in the problem, aware, however, that the therapeutic decision must be taken on an individual basis: patient characteristics/experience of the care team. For its development it was adopted the Nominal Group Technique methodology. The Levels of Evidence and Grades of Recommendation were established according to the criteria of the Oxford Centre for Evidence-Based Medicine. In addition, expert recommendations were added briefly to each of the items analysed.

Atypical caudal regression syndrome with lumbar agenesis, hypoplastic sacrum without sacroiliac joints in the eastern Democratic Republic of Congo: a case report

The agenesis of any segment of the lower spinal column referred to as "caudal regression syndrome" (CRS) is a rare congenital defect of the spine. This malformation is characterized by the absence of some or the entire lumbosacral vertebral segment. Etiological factors remain unknown. We report an atypical caudal regression syndrome with lumbar agenesis, disconnected from the remaining hypoplastic sacrum, in the Eastern part of the Democratic Republic of Congo (DRC).An 11-month-old female infant with no particular fetal or maternal history presented limb weakness with flexed knees and flanges in the popliteal fossae, sphincter atony, and a sensation of emptiness on palpation in the lumbosacral region. A 3D CT scan of the spine showed the absence of the lumbar spine and disconnection of the upper segment of the thoracic spine from the hypoplastic sacrum. We noted also the absence of the sacroiliac joints bilaterally and an unusual trigonal shape of the iliac bones. MRI and sonographic examination are required in the investigation of the disease. The management is multidisciplinary and depends upon the degree of the defect. Spine reconstruction has proven to be a valuable management technique but has many complications. We wanted to draw the medical world's attention to the existence of this extremely rare malformation in the east of the Democratic Republic of Congo, a mining area.

Evaluation of optical tracking and augmented reality for needle navigation in sacral nerve stimulation

BACKGROUND AND OBJECTIVE

Sacral nerve stimulation (SNS) is a minimally invasive procedure where an electrode lead is implanted through the sacral foramina to stimulate the nerve modulating colonic and urinary functions. One of the most crucial steps in SNS procedures is the placement of the tined lead close to the sacral nerve. However, needle insertion is very challenging for surgeons. Several x-ray projections are required to interpret the needle position correctly. In many cases, multiple punctures are needed, causing an increase in surgical time and patient's discomfort and pain. In this work we propose and evaluate two different navigation systems to guide electrode placement in SNS surgeries designed to reduce surgical time, minimize patient discomfort and improve surgical outcomes.

METHODS

We developed, for the first alternative, an open-source navigation software to guide electrode placement by real-time needle tracking with an optical tracking system (OTS). In the second method, we present a smartphone-based AR application that displays virtual guidance elements directly on the affected area, using a 3D printed reference marker placed on the patient. This guidance facilitates needle insertion with a predefined trajectory. Both techniques were evaluated to determine which one obtained better results than the current surgical procedure. To compare the proposals with the clinical method, we developed an x-ray software tool that calculates a digitally reconstructed radiograph, simulating the fluoroscopy acquisitions during the procedure. Twelve physicians (inexperienced and experienced users) performed needle insertions through several specific targets to evaluate the alternative SNS guidance methods on a realistic patient-based phantom.

RESULTS

With each navigation solution, we observed that users took less average time to complete each insertion (36.83 s and 44.43 s for the OTS and AR methods, respectively) and needed fewer average punctures to reach the target (1.23 and 1.96 for the OTS and AR methods respectively) than following the standard clinical method (189.28 s and 3.65 punctures).

CONCLUSIONS

To conclude, we have shown two navigation alternatives that could improve surgical outcome by significantly reducing needle insertions, surgical time and patient's pain in SNS procedures. We believe that these solutions are feasible to train surgeons and even replace current SNS clinical procedures.

Electroceuticals in the Gastrointestinal Tract

The field of electroceuticals has attracted considerable attention over the past few decades as a novel therapeutic modality. The gastrointestinal (GI) tract (GIT) holds significant potential as a target for electroceuticals as the intersection of neural, endocrine, and immune systems. We review recent developments in electrical stimulation of various portions of the GIT (including esophagus, stomach, and small and large intestine) and nerves projecting to the GIT and supportive organs. This has been tested with varying degrees of success for several dysmotility, inflammatory, hormonal, and neurologic disorders. We outline a vision for the future of GI electroceuticals, building on advances in mechanistic understanding of GI physiology coupled with novel ingestible technologies. The next wave of electroceutical therapies will be minimally invasive and more targeted than current approaches, making them an indispensable tool in the clinical armamentarium.

Surgical Planning of Sacral Nerve Stimulation Procedure in Presence of Sacral Anomalies by Using Personalized Polymeric Prototypes Obtained with Additive Manufacturing Techniques

Sacral nerve stimulation or sacral neuromodulation involves the implantation of a stimulating electrode lead through the sacral foramina. In patients with anatomical sacral anomalies, it can constitute a challenging procedure due to a lack of common reference points present in the normal anatomy. In this study, we present an innovative application of additive manufacturing for the planning of sacral nerve stimulation techniques and related surgical procedures in complex cases, and we verify that the use of personalized patient models may help to manage the presence of sacral anomalies. The use of two alternative additive manufacturing technologies working with thermoplastic and thermoset polymers, including fused deposition modeling as low-cost alternative and laser stereolithography as industrial gold standard, is compared in terms of viability, precision and overall production costs. They pay special attention to fidelity in terms of the bone microstructure reconstruction, which is necessary for adequately planning electrode insertion. Advantages and limitations of the alternative approaches are discussed and ideas for future developments and for solving current challenges are presented.

Urine retention as the first presentation of congenital absence of the sacrum: A case report of a rare clinical phenomenon

RATIONALE

Congenital absence of either a part of or the entire sacrum is rare, and only a few such cases have been reported until now. Most cases showed vertebral, pelvic, neurological, and visceral abnormalities, and the cases were usually quite serious. Only in rare cases was there urine retention without other symptoms.

PATIENT CONCERNS

We describe the case of a 28-years-old man who presented with urine retention.

DIAGNOSES

Urodynamic study confirmed that he had urinary retention, and magnetic resonance imaging (MRI) showed the absence of the sacrum.

INTERVENTIONS

He was treated with electro-acupuncture and medications to improve nerve function.

OUTCOMES

His symptoms showed clear improvement.

LESSONS

Although this case is rare, it indicates that the spine and pelvis may need to be examined when unexplained urinary retention occurs.

A novel three-dimensional printed guiding device for electrode implantation of sacral neuromodulation

AIM

The aim was to test the feasibility of a novel three-dimensional (3D) printed guiding device for electrode implantation of sacral neuromodulation (SNM).

METHOD

A 3D printed guiding device for electrode implantation was customized to patients' anatomy of the sacral region. Liquid photopolymer was selected as the printing material. The details of the device designation and prototype building are described. The guiding device was used in two patients who underwent SNM for intractable constipation. Details of the procedure and the outcomes are given.

RESULTS

With the help of the device, the test needle for stimulation was placed in the target sacral foramen successfully at the first attempt of puncture in both patients. The time to implant a tined SNM electrode was less than 20 min and no complications were observed. At the end of the screening phase, symptoms of constipation were relieved by more than 50% in both patients and permanent stimulation was established.

CONCLUSION

The customized 3D printed guiding device for implantation of SNM is a promising instrument that facilitates a precise and quick implantation of the electrode into the target sacral foramen.