Experimental Models of Neuropathic Fecal Incontinence: An Animal Model of Childbirth Injury to the Pudendal Nerve and External Anal Sphincter

2008 ◽  
Vol 51 (11) ◽  
pp. 1619-1626 ◽  
Author(s):  
C. F. Healy ◽  
C. OʼHerlihy ◽  
C. OʼBrien ◽  
P. R. OʼConnell ◽  
J. F. X. Jones
Keyword(s):  
Animal Model ◽  
Fecal Incontinence ◽  
Anal Sphincter ◽  
External Anal Sphincter ◽  
Pudendal Nerve ◽  
Experimental Models

scholarly journals Intraoperative monitoring for tethered cord surgery: an update

2004 ◽  
Vol 16 (2) ◽  
pp. E8 ◽  
Author(s):  
Karl F. Kothbauer ◽  
Klaus Novak
Keyword(s):  
Electrical Stimulation ◽  
Anal Sphincter ◽  
External Anal Sphincter ◽  
Continuous Monitoring ◽  
Pudendal Nerve ◽  
Tethered Cord ◽  
Sensory Pathways ◽  
Functional Integrity ◽  
Muscle Responses ◽  
Stimulation Of

Object Intraoperative neurophysiological recording techniques have found increasing use in neurosurgical practice. The development of new recording techniques feasible while the patient receives a general anesthetic have improved their practical use in a similar way to the use of digital recording, documentation, and video technology. This review intends to provide an update on the techniques used and their validity. Methods Two principal methods are used for intraoperative neurophysiological testing during tethered cord release. Mapping identifies functional neural structures, namely nerve roots, and monitoring provides continuous information on the functional integrity of motor and sensory pathways as well as reflex circuitry. Mapping is performed mostly by using direct electrical stimulation of a structure within the surgical field and recording at a distant site, usually a muscle. Sensory mapping can also be performed with peripheral stimulation and recording within the surgical site. Monitoring of the motor system is achieved with motor evoked potentials. These are evoked by transcranial electrical stimulation and recorded from limb muscles and the external anal sphincter. The presence or absence of muscle responses are the parameters monitored. Sensory potentials evoked by tibial or pudendal nerve stimulation and recorded from the dorsal columns via an epidurally inserted electrode and/or from the scalp as cortical responses are used to access the integrity of sensory pathways. Amplitudes and latencies of these responses are then interpreted. The bulbocavernosus reflex, with stimulation of the pudendal nerve and recording of muscle responses in the external anal sphincter, is used for continuous monitoring of the reflex circuitry. Presence or absence of this response is the pertinent parameter that is monitored. Conclusions Intraoperative neurophysiology provides a wide and reliable set of techniques for intraoperative identification of neural structures and continuous monitoring of their functional integrity.

Stress, Urge, and Mixed Types of Partial Fecal Incontinence: Pathogenesis, Clinical Presentation, and Treatment

2007 ◽  
Vol 73 (1) ◽  
pp. 6-9
Author(s):  
Ahmed Shafik ◽  
Olfat El Sibai ◽  
Ismail A. Shafik ◽  
Ali A. Shafik
Keyword(s):  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
External Anal Sphincter ◽  
Clinical Presentation ◽  
Individual Treatment ◽  
Electromyographic Activity ◽  
Postanal Repair ◽  
Different Types ◽  
Mixed Types

The authors investigated the hypothesis that partial fecal incontinence (PFI) had variable manifestations that can be categorized as different types of PFI with different pathogeneses and treatment. Anal and rectal pressures as well as external and internal anal sphincter electromyographic activity were recorded in 163 patients with PFI and in 25 healthy volunteers. Patients were treated with biofeedback or surgically. Three types of PFI were encountered: stress fecal incontinence (SFI; 55 patients), urge fecal incontinence (UFI; 72 patients), and mixed fecal incontinence (MFI; 36 patients). Anal pressure decreased in three groups in which MFI had the lowest pressure. A significant reduction in external anal sphincter electromyographic activity occurred in SFI, in internal anal sphincter electromyographic activity in UFI, and of both sphincters in MFI. Bio-feedback cured 36 of 55 patients and postanal repair cured 10 of 19 patients with SFI. Forty-eight of 72 patients with UFI responded to biofeedback and 16 of 24 responded to internal anal sphincter repair. Biofeedback failed in MFI patients. Twenty-four of 27 patients who consented to operative correction of the sphincteric defect were cured. Three types of PFI could be identified: SFI, UFI, and MFI. Each type has its own etiology and symptoms, and requires individual treatment. Biofeedback succeeded in treating the majority of SFI and UFI patients. Surgical correction of the anal sphincter was performed after biofeedback failure.

Spinal and pudendal nerve modulation of human corticoanal motor pathways

1998 ◽  
Vol 274 (2) ◽  
pp. G419-G423 ◽  
Author(s):  
Shaheen Hamdy ◽  
Paul Enck ◽  
Qasim Aziz ◽  
John C. Rothwell ◽  
Samet Uengoergil ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Nerve Stimulation ◽  
External Anal Sphincter ◽  
Neural Control ◽  
Pudendal Nerve ◽  
Cortical Stimulation ◽  
Evoked Responses ◽  
Pudendal Nerve Stimulation ◽  
Sphincter Function ◽  
Sensorimotor Interactions

We investigated the effects of lumbosacral and pudendal nerve stimulation on the corticofugal pathways to the human external anal sphincter. In 11 healthy subjects, anal sphincter electromyographic responses, evoked to transcranial magnetic stimulation of the motor cortex, were recorded 5–500 ms after lumbosacral root or pudendal nerve stimulation. Lumbosacral and pudendal nerve stimulation alone evoked responses with amplitudes of 293 ± 73 and 401 ± 153 μV and latencies of 3.2 ± 0.2 and 2.2 ± 0.2 ms, respectively. Cortical stimulation also evoked responses with amplitudes of 351 ± 104 μV and latencies of 20.9 ± 1.1 ms. When lumbosacral or pudendal nerve stimulation preceded cortical stimulation, the cortically evoked responses were facilitated ( P < 0.01), with the effect appearing greatest at 5–20 ms after both lumbosacral and pudendal excitation and at 50–100 ms after lumbosacral excitation alone. Our results demonstrate that cortical pathways to the external anal sphincter are facilitated by prior lumbosacral and pudendal nerve stimulation, indicating that sensorimotor interactions are important in the central neural control of sphincter function.

Pudendal Nerve Damage Increases the Risk of Fecal Incontinence in Women With Anal Sphincter Rupture After Childbirth

1996 ◽  
Vol 51 (3) ◽  
pp. 156-157
Author(s):  
Tine Tetzschner ◽  
Michael Sorensen ◽  
Ole O. Rasmussen ◽  
Gunnar Lose ◽  
John Christiansen
Keyword(s):  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Pudendal Nerve ◽  
Nerve Damage ◽  
Sphincter Rupture

Effects of Pregnancy, Parturition, and Anal Sphincter Transection on Function of the External Anal Sphincter in an Animal Model

2009 ◽  
Vol 113 (4) ◽  
pp. 909-916 ◽  
Author(s):  
David D. Rahn ◽  
Amanda B. White ◽  
Rodney T. Miller ◽  
R Ann Word ◽  
Clifford Y. Wai
Keyword(s):  
Animal Model ◽  
Anal Sphincter ◽  
External Anal Sphincter

scholarly journals MIOPLASTIA EXPERIMENTAL DO ESFÍNCTER ANAL EXTERNO COM Fascia lata AUTÓLOGA, EM CÃES

2000 ◽  
Vol 5 (1) ◽  
Author(s):  
S. RODASKI ◽  
S. D. GUÉRIOS ◽  
A. B. KOPPE ◽  
P. C. SINCERO ◽  
M. V. TRANQUILIN ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Effective Treatment ◽  
Anal Sphincter ◽  
External Anal Sphincter ◽  
Surgical Techniques ◽  
Fascia Lata ◽  
Anal Stenosis ◽  
Healthy Male ◽  
Anal Sphincteroplasty

A incontinência fecal em cães e gatos é uma situação na qual o proprietário tem dificuldades para resolver as conseqüências advindas desta lesão, e geralmente os pacientes são submetidos à eutanásia. Algumas técnicas cirúrgicas empregadas na esfincteroplastia são passíveis de complicações como estenose anal ou incontinência fecal. Este experimento teve como objetivo reconstituir o músculo esfíncter anal externo em cães, após iatrogenização da incontinência fecal. Foram utilizados 10 cães hígidos, machos, sem raça definida, com peso variando entre 9 a14 kg. Após incisão de pele circundando a abertura anal, procedeu-se a miectomia bilateral de esfíncter anal externo, iatrogenizando-se a incontinência fecal, a qual foi diagnosticada por meio de avaliação física diária. Trinta dias após, os pacientes foram novamente preparados para cirurgia asséptica e submetidos à esfincteroplastia anal externa com o uso de Fascia lata autológa medindo 8 cm de comprimento e 0,5 cm de largura, em média. Os dez cães incontinentes, em decorrência da miectomia do esfíncter anal externo, apresentaram controle da emissão de fezes em 10 dias após a realização da esfincteroplastia e mantiveram-se assim durante os dois meses de observação póscirúrgica. Dessa maneira concluiu-se que a mioplastia do esfíncter anal externo com Fascia lata autóloga, representa um procedimento eficaz de simples e rápida aplicação, podendo ser utilizado rotineiramente para restabelecer a continência fecal em cães. Experimental myoplasty of the external anal sphincter with autologous Fascia lata in dogs Abstract Fecal incontinence in dogs and cats is a hard condition for owners to solve the consequences of this lesion, being patients usually subjected to euthanasia. Some surgical techniques used in sphincteroplasty are prone to complications such as anal stenosis or fecal incontinence. This experiment objectified to reconstruct the external anal sphincter in dogs after iatrogeny of the fecal incontinence. Ten healthy male dogs of undefined breed, weight ranging from 9 to 14 kg, were used. After dermal incision surrounding the anal opening, bilateral myectomy of the external anal sphincter was performer, with iatrogeny of fecal incontinence, diagnosed by daily physical evaluation. Thirty days later, patients were again prepared for aseptic surgery and went under external anal sphincteroplasty using autologous Fascia lata averaging 8 cm long and 0,5 cm wide. Ten incontinent dogs, due to external anal sphincter myectomy, presented fecal control in ten days after surgery and for the two subsequent months of follow-up. In conclusion, myoplasty of external anal sphincter using autologous Fascia lata is a simple and effective treatment that can be used in fecal incontinence in dogs.

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