Electrical Stimulation for Pelvic Floor Disorders

"This book will enable the reader to gain a sound understanding of contemporary and futuristic evidence-based interventions and assessment procedures for pelvic floor disorders. It gathers the experiences of some of the most important experts on electrical stimulation techniques, offering a multidisciplinary and problem-oriented approach organized according to therapeutic goals. Interventions are recommended that are consistent with theory and display clinical efficacy for specific disorders, including urinary incontinence or retention, fecal incontinence, constipation, pelvic pain, sexual dysfunction, and neurological diseases involving the pelvic floor. All of the surgical or rehabilitative techniques requiring electrical stimulation for the treatment of these disorders are explored, and essential background information is provided on functional anatomy, neurophysiology, and concepts in electrotherapy. This volume will be a very useful tool for urologists, general or colorectal surgeons, gynecologists, and anesthesiologists, and also physiotherapists and alternative medicine practitioners (a specific chapter focuses on electroacupuncture). It will assist in their clinical practice as they seek to help the very many patients who suffer from any of the wide range of functional pelvic floor disorders"--Publisher's description Foreword I 6 Foreword II 8 Preface 10 Contents 12 Contributors 14 1: Electrotherapy for Pelvic Floor Disorders: Historical Background 17 1.1 Introduction 17 1.2 Early Historical Reports 18 1.3 Franklinism, Galvanism, and Faradism: The Golden Age (1750–1900) 20 1.4 Revival of Electrotherapy for Pain and Pelvic Floor Disorders 26 1.5 Electricity: Between Therapy and Magic 27 References 32 2: Functional Anatomy of the Pelvic Floor 35 2.1 Introduction 35 2.2 Bones 36 2.3 Muscles, Fascia, and Connective Tissue Support 36 2.3.1 Pelvic Diaphragm: Levator Ani and Coccygeus Muscles 38 2.3.2 Perineum, Perineal Membrane, and Perineal Body 40 2.3.3 Urethral Sphincter Complex and Urethral Continence Mechanism 42 2.3.4 Anal Sphincter Complex and Anal Continence Mechanism 45 2.3.5 Endopelvic Fascia and Connective Tissue Supports to the Pelvic Organs 49 2.3.5.1 Three Levels of Vaginal Support 50 2.3.5.2 Rectovaginal Fascia 51 2.4 Controversial Issues in Pelvic Floor Anatomy 51 2.4.1 Conversation with a Urogynecologist 51 2.4.2 Conversation With a Coloproctologist 53 2.4.3 Conversation with a General Abdominal Surgeon 54 References 55 3: Neurophysiology and Neurophysiological Evaluation of the Pelvic Floor 59 3.1 Neural Control of Urinary Tract 59 3.2 Neural Control of Intestinal Tract 64 3.3 Neurophysiological Evaluation of Pelvic Floor 65 3.3.1 Electromyography (EMG) 66 3.3.2 Sacral Reflexes 67 3.3.3 Somatosensory-Evoked Potential (SEP) 69 3.3.4 Motor-Evoked Potential (MEP) 71 3.3.5 Sympathetic Skin Response (SSR) 71 3.3.6 Pudendal Nerve Terminal Motor Latency (PNTML) 73 References 74 4: Basic Concepts in Electricity and Electrotherapy 77 4.1 Introduction 77 4.2 Electrotherapeutic Window 78 4.3 The Bioelectric Body and the Bioelectric Cell 78 4.4 Fundamental Concepts of Electricity 81 4.4.1 Electric Charge 81 4.4.2 Conductors and Insulators 83 4.4.3 Electrical Current: Ampere and Voltage 83 4.4.4 Resistance and Conductance 84 4.4.5 Capacitance and Impedance 85 4.5 Intuitive Approach to Electric Parameters 85 4.6 Stimulation Parameters 86 4.6.1 Frequency 86 4.6.2 Pulse Width 87 4.6.3 Amplitude 88 References 88 5: Acupuncture for Pelvic Floor Disorders 91 5.1 Acupuncture: A Traditional Technique Moving from Empiricism to a Modern Era 91 5.2 Acupuncture in Functional Gastrointestinal Disorders 92 5.3 Acupuncture for Urinary Tract Diseases 98 5.4 Acupuncture for Sexual Dysfunction 101 5.5 Conclusions 101 References 101 6: Electrical Stimulation, Biofeedback, and Other Rehabilitative Techniques 105 6.1 Fecal Disorder Rehabilitation 105 6.2 Anal Electrical Stimulation 105 6.3 Biofeedback 106 6.4 Pelvic Floor Muscle Training 107 6.5 Sensory Retraining 107 References 108 7: Functional Electrical Stimulation (FES) in Micturition Disorders 111 7.1 Introduction 111 7.2 Neurophysiologic Basis of FES Employment in Micturition Disorders 112 7.3 FES in Micturition Disorders: Materials and Methods 113 7.4 FES in Micturition Disorders: Clinical Results and Remarks 117 7.5 Conclusions 118 References 118 8: Transcutaneous Electrical Nerve Stimulation 121 8.1 Introduction 121 8.2 TENS Mechanisms 122 8.3 TENS Parameters 124 8.3.1 Frequency 124 8.3.2 Pulse Duration 125 8.3.3 Duty Cycle 125 8.3.4 Stimulation Intensity 125 8.4 TENS and Vulvar Pain 126 8.5 TENS and Urinary Dysfunction 129 8.6 TENS and Bowel Dysfunction 130 8.7 Conclusion 131 References 131 9: Tibial Nerve Stimulation 134 9.1 Introduction 134 9.2 PTNS Technique 135 9.3 Results 136 9.3.1 The Urological Experience 136 9.3.1.1 Overactive Bladder (OAB) Syndrome 136 OAB and Long-Term Efficacy 137 9.3.1.2 Neurogenic Bladder 137 9.3.1.3 Non-Obstructive Urinary Retention 138 9.3.1.4 Chronic Pelvic Pain 138 9.3.2 The Colorectal Experience 138 9.4 Conclusions 140 References 140 10: Sacral Nerve Modulation: Techniques and Indications 144 10.1 Introduction 144 10.2 One-Stage vs. Two-Stage Implant of InterStim Therapy 145 10.3 Development of the Tined Lead 146 10.4 Conclusions 150 References 150 11: Sacral Nerve Modulation for Urinary Disorders: Overactive Bladder 151 11.1 Introduction 151 11.2 General Principles of Treatment 151 11.2.1 Medical Treatment 152 11.2.2 Minimally Invasive Techniques 152 11.3 Sacral Neuromodulation 153 11.3.1 Efficacy 153 11.3.2 Quality of Life 154 11.3.3 Adverse Events 155 11.3.4 SNM Versus Botulin Toxin 155 11.3.5 Cost-Effectiveness 155 11.4 Conclusions 156 References 156 12: Sacral Nerve Modulation for Urinary Disorders: Urinary Retention 159 12.1 Introduction 159 12.2 Urinary Retention. Two Main Actors: The Detrusor and the Urethral Sphincter 160 12.3 How to Manage Urinary Retention: From Conservative Options to Functional Therapy 161 12.4 Sacral Neuromodulation: From Testing Its Efficacy to Follow-Up of Permanent Implant 163 12.4.1 Results 165 12.5 Conclusions 165 References 166 13: Sacral Nerve Modulation for Fecal Incontinence 168 13.1 Background 168 13.2 Indication for SNS Therapy 168 13.3 Technical Evolution 169 13.4 The Procedure of SNS 173 13.5 Stimulation Parameters 173 13.6 Outcome Evaluation 173 13.7 Mechanisms of Action 174 13.8 Long-Term Outcome 174 References 175 14: Sacral Nerve Modulation for Constipation 178 14.1 Introduction 178 14.2 Mechanism of Action 180 14.3 Selection of Patients 181 14.3.1 Inclusion and Exclusion Criteria 181 14.3.2 Investigations 183 14.3.3 Clinical Predictors 183 14.4 Efficacy 184 14.5 Clinical Considerations 186 14.6 Conclusions and Future Perspectives 188 References 189 15: Pudendal Nerve Modulation 192 15.1 Electrical Modulation of the Pudendal Nerve 192 15.2 Surgical Technique 193 15.2.1 Lead Implant 193 15.2.2 Preparation for Lead Insertion 194 15.2.3 Acute Test with Test Needle to Locate Optimal Position 195 15.2.4 Tined Lead Insertion 195 15.2.5 Tunnelization from Pocket Site to Incision Site and Lead Connection to the Test Stimulator 197 15.2.6 Parameter Settings 197 References 198 16: Dynamic Graciloplasty 199 16.1 Historical Background 199 16.2 Current Indications for DGP 201 16.3 Technique of Dynamic Graciloplasty: General Aspects 203 16.4 Dynamic Graciloplasty in Fecal Incontinence 203 16.4.1 Preparation of Native Anorectum in Fecal Incontinence 205 16.5 Graciloplasty and TAR 205 16.6 Positioning of the Gracilis Muscle and Dynamization 206 16.7 Electrostimulation Training 207 16.8 Complications 208 16.9 Functional Results 208 16.10 Quality of Life (QOL) 209 16.11 Comment by the Authors 210 References 210 17: Electrical Stimulation in Sexual Dysfunction 213 17.1 Introduction 213 17.2 Sexual Dysfunction and Pelvic Pain Disorders 216 17.3 General Treatment Principles 218 17.4 Electrotherapies for Sexual Dysfunctions 219 17.4.1 Neuromodulation for Female Sexual Dysfunction 219 17.4.2 Neuromodulation for Erectile Dysfunction 223 17.4.3 Functional Electrical Stimulation and Rehabilitative Techniques 224 17.4.4 Electroejaculation for Ejaculatory Dysfunction 225 17.4.5 Acupuncture for Sexual Dysfunction 228 References 230 18: Electrical Stimulation for Pelvic Pain 236 18.1 Introduction 236 18.2 Transcutaneous Electrical Nerve Stimulation (TENS) 238 18.3 Percutaneous Tibial Nerve Stimulation (PTNS) 239 18.4 Neuromodulation of Sacral Roots (SNM) 240 18.5 Conclusion 242 References 243 19: Pelvic Floor Neuromodulation in Neurologic Patients 245 19.1 Background 245 19.2 Neurogenic Lower Urinary Tract Dysfunction 246 19.2.1 Sacral Nerve Modulation 247 19.2.2 Pudendal and Dorsal Genital Nerves Modulation 249 19.2.3 Tibial Nerve Stimulation 250 19.2.4 Sacral Rhizotomies and Electrical Bladder Stimulation 251 19.2.5 Intravesical Electrical Stimulation 252 19.3 Neurogenic Bowel Dysfunction 253 19.3.1 Sacral Nerve Modulation 254 19.3.2 Tibial Nerve Stimulation 255 19.3.3 Sacral Rhizotomies and Electrical Bowel Stimulation 255 19.4 Conclusion 256 References 256 20: New Frontiers: Electrical Stimulation in Urinary Disorders 260 21: New Frontiers: Electrical Stimulation in Colorectal Disorders 263 21.1 Colonic Electrical Stimulation (Colonic Pacing) 263 21.2 Dorsal Genital Nerve Stimulation 265 21.3 Magnetic Stimulation 266 References 267 Front Matter....Pages i-xv Electrotherapy for Pelvic Floor Disorders: Historical Background....Pages 1-18 Functional Anatomy of the Pelvic Floor....Pages 19-42 Neurophysiology and Neurophysiological Evaluation of the Pelvic Floor....Pages 43-60 Basic Concepts in Electricity and Electrotherapy....Pages 61-74 Acupuncture for Pelvic Floor Disorders....Pages 75-88 Electrical Stimulation, Biofeedback, and Other Rehabilitative Techniques....Pages 89-94 Functional Electrical Stimulation (FES) in Micturition Disorders....Pages 95-104 Transcutaneous Electrical Nerve Stimulation....Pages 105-117 Tibial Nerve Stimulation....Pages 119-128 Sacral Nerve Modulation: Techniques and Indications....Pages 129-135 Sacral Nerve Modulation for Urinary Disorders: Overactive Bladder....Pages 137-144 Sacral Nerve Modulation for Urinary Disorders: Urinary Retention....Pages 145-153 Sacral Nerve Modulation for Fecal Incontinence....Pages 155-164 Sacral Nerve Modulation for Constipation....Pages 165-178 Pudendal Nerve Modulation....Pages 179-185 Dynamic Graciloplasty....Pages 187-200 Electrical Stimulation in Sexual Dysfunction....Pages 201-223 Electrical Stimulation for Pelvic Pain....Pages 225-233 Pelvic Floor Neuromodulation in Neurologic Patients....Pages 235-249 New Frontiers: Electrical Stimulation in Urinary Disorders....Pages 251-253 New Frontiers: Electrical Stimulation in Colorectal Disorders....Pages 255-260