Neurourology and urodynamics
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Uncoordinated contraction of the external urethral sphincter is prevalent in individuals with spinal cord injury and can prevent bladder voiding. The aim of this study was to demonstrate that complete and reversible sinusoidal high frequency alternating current (HFAC) conduction block of the pudendal nerves (PN) can eliminate external urethral sphincter activation and produce low residual bladder voiding. ⋯ These results demonstrate that bilateral HFAC block of the PN can produce effective voiding. Neural prostheses using this approach may provide an alternative method for producing micturition for people with spinal cord injury.
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Clinical Trial
Effect of lumbar-epidural administration of tramadol on lower urinary tract function.
Intrathecal and epidural administration of micro-agonist opioids is associated with urinary retention, a potentially serious adverse-event. In animal studies tramadol has been found not to affect voiding function. We evaluated urodynamic effects of epidural tramadol in humans. ⋯ Epidural tramadol increases the bladder capacity and compliance and delays filling-sensations, without ill effect on voiding. This seems true even for patients with obstructed outflow; however, due to small number of patients a definite conclusion cannot be derived. These results will guide clinician to avoid catheterization in cases where epidural tramadol is used for postoperative pain. The inhibitory effects of tramadol on EMG activity are intriguing and need further studies.
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The diagnosis of pudendal neuralgia by pudendal nerve entrapment syndrome is essentially clinical. There are no pathognomonic criteria, but various clinical features can be suggestive of the diagnosis. We defined criteria that can help to the diagnosis. ⋯ The diagnosis of pudendal neuralgia by pudendal nerve entrapment syndrome is essentially clinical. There are no specific clinical signs or complementary test results of this disease. However, a combination of criteria can be suggestive of the diagnosis.
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Comparative Study
Unilateral versus bilateral stage I neuromodulator lead placement for the treatment of refractory voiding dysfunction.
To determine if bilateral S3 lead placement during the stage I trial period improves the "success" rate for advancing to stage II (permanent) sacral neuromodulator placement. ⋯ Bilateral stage I neuromodulation trial provides a significantly higher rate of improvement in refractory voiding symptoms to allow for the progress to stage II implantation.