Sacral Nerve Stimulation
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Sacral Nerve Stimulation
Pelvic Floor- A 78-year-old woman with fecal incontinence presents for sacral neuromodulator placement. During placement of the nerve probe, in which areas should the patient report increased sensation as an indication of proper placement of the stimulator probe?
- A 67-year-old woman has daily episodes of solid stool incontinence. Workup includes endoanal ultrasonography, which shows a 70-degree sphincteric defect, and anorectal manometry, which demonstrates low squeeze and resting pressures. Pudendal nerve terminal latency is 2.5 ms bilaterally. She has tried pelvic floor biofeedback without improvement. What is the best next step in treatment?
Pelvic Floor- A 50-year-old woman, gravida 2, para 2, comes to your office reporting chronic constipation for 30 years. Her last colonoscopy was 6 months ago; findings showed a single 6-mm tubular adenoma, which was resected. She takes a daily polyethylene glycol 3350 (PEG) powder and psyllium husk and still only has two hard bowel movements a week. She admits to frequent manual disimpaction and weekly enemas. Magnetic resonance imaging (MRI) defecography demonstrated a 1.5-cm rectocele, which emptied with evacuation, and an anorectal manometry demonstrated paradoxical squeeze and incomplete sphincter relaxation consistent with obstructive defection. What is the best initial treatment option to improve her constipation?
- A 75-year-old female patient with diabetes is in your office undergoing placement of a sacral neuromodulator lead for progressive fecal incontinence. Of the following clinical signs, which indicates that the lead is appropriately positioned?
- A 75-year-old female patient with fecal incontinence presents for stage 1 sacral neuromodulation. Upon lead stimulation, which of the following findings would be associated with optimal lead position?
- A 75-year-old man with a remote history of fistulotomy and radiation therapy for prostate cancer presents for evaluation of his worsening fecal incontinence. He has poor sphincter tone and a palpable muscular defect. Anal manometry confirms diminished resting and squeeze pressures that do not improve after pelvic floor physical therapy with biofeedback. His symptoms persist despite bowel habit optimization and sacral nerve stimulator implantation. The best next option for ths patient is
Bowel Dysfunction Low Anterior Resection Syndrome
Fecal Incontinence: Evaluation and Treatment- Low Anterior Resection Syndrome (LARS)
- Colonic Physiology
- Functional Disorders After Colorectal Surgery/IBS
- Common Tests for the Pelvic Floor
- Anorectal Physiology
Management of Fecal Incontinence (2023)- Pediatric Colorectal Disorders
- Malignancy
- A 64-year-old man received neoadjuvant chemoradiotherapy followed by a low anterior resection 3 years ago for the treatment of rectal cancer. He complains of persistent fecal urgency, occasional fecal incontinence, clustered stools, and incomplete evacuation, which has persisted since the time of surgery. What is the most likely cause of these symptoms?
- A 68-year-old man with a history of a hemorrhoidectomy and fecal urgency presents with a T3n1m0 rectal cancer 5 cm from the anal verge. He has no family history of colorectal cancer. What is the most important consideration when counseling the patient about his surgical treatment options?
- Evaluation of Constipation and Treatment of Abdominal Component
- Video Mentorship Series
- Proctectomy for Rectal Cancer