Abstract
Background and purpose
The effects of neuromodulation with sacral magnetic stimulation (SMS) were examined in postoperative patients with bowel or bladder dysfunction.
Patients and methods
SMS was performed at the S3 level using a MagPro® instrument (Medtronic Inc., USA) while the patients were under light sedation. One treatment course consisted of stimulation delivered at 15 Hz for 5 s, 10 times over an interval of 1 min. Three patients with bladder or bowel dysfunction refractory to conservative treatment were examined.
Results
Case 1 is a 7-year-old male with a rectourethral fistula. This patient developed a hyperdynamic bladder after a laparoscopic pull-through operation at the age of 7 months. The administration of an anticholinergic agent slightly improved the condition. SMS was started at the age of 4 years with one trial each year. A marked expansion of bladder volume from 20 ml before trial to 120 ml after the third trial was obtained. Case 2 (a 4-year old female with a recto-vaginal fistula) and Case 3 (a 8-year-old female with an ano-vestibular fistula) showed severe constipation after radical surgery during infancy. Case 2 needed appendicostomy. After SMS, bowel movements could become controllable with enemas. No adverse effects were observed for any of the three cases.
Conclusions
These results suggest that SMS might be a useful modality to improve postoperative bowel or bladder dysfunction.
Similar content being viewed by others
References
Leroi AM, Parc Y, Lehur PA, Mion F, Barth X, Rullier E, Bresler L, Portier G, Michot F (2005) Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 242:662–669
Kenefick NJ, Vaizey CJ, Cohen RC, Nicholls RJ, Kamm MA (2002) Medium-term results of permanent sacral nerve stimulation for faecal incontinence. Br J Surg 89:896–901
Matzel KE, Kamm MA, Stosser M, Baeten CG, Christiansen J, Madoff R, Mellgren A, Nicholls RJ, Rius J, Rosen H (2004) Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 363:1270–1276
Jarrett ME, Mowatt G, Glazener CM, Fraser C, Nicholls RJ, Grant AM, Kamm MA (2004) Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 91:1559–1569
Kenefick NJ, Christiansen J (2004) A review of sacral nerve stimulation for the treatment of faecal incontinence. Colorectal Dis 6:75–80
Tanagho EA, Schmidt RA (1988) Electrical stimulation in the clinical management of the neurogenic bladder. J Urol 140:1331–1339
Hassouna MM, Siegel SW, Nyeholt AA, Elhilali MM, van Kerrebroeck PE, Das AK, Gajewski JB, Janknegt RA, Rivas DA, Dijkema H, Milam DF, Oleson KA, Schmidt RA (2000) Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol 163:1849–1854
Weil EH, Ruiz-Cerda JL, Eerdmans PH, Janknegt RA, Bemelmans BL, van Kerrebroeck PE (2000) Sacral root neuromodulation in the treatment of refractory urinary urge incontinence: a prospective-randomized clinical trial. Eur Urol 37:161–171
Kubota M, Okuyama N, Hirayama Y, Kobayashi K, Satoh K (2007) Effect of sacral magnetic stimulation on the anorectal manometric activity: a new modality for examining sacro-rectoanal interaction. Pediatr Surg Int 23:741–745
Maccabee PJ, Lipitz ME, Desudchit T, Golub RW, Nitti VW, Bania JP, Willer JA, Cracco RQ, Cadwell J, Hotson GC, Eberle LP, Amassian VE (1996) A new method using neuromagnetic stimulation to measure conduction time within the cauda equina. Electroencephalogr Clin Neurophysiol 101:153–166
McFarlane JP, Foley SJ, de Winter P, Shah PJ, Craggs MD (1997) Acute suppression of idiopathic detrusor instability with magnetic stimulation of the sacral nerve roots. Br J Urol 80:734–741
Fujishiro T, Enomoto H, Ugawa Y, Takahashi S, Ueno S, Kitamura T (2000) Magnetic stimulation of the sacral roots for the treatment of stress incontinence: an investigational study and placebo controlled trial. J Urol 164:1277–1279
Fujishiro T, Takahashi S, Enomoto H, Ugawa Y, Ueno S, Kitamura T (2002) Magnetic stimulation of the sacral roots for the treatment of urinary frequency and urge incontinence: an investigational study and placebo controlled trial. J Urol 168:1036–1039
Shaker H, Wang Y, Loung D, Balbaa L, Fehlings MG, Hassouna MM (2000) Role of C-afferent fibres in the mechanism of action of sacral nerve root neuromodulation in chronic spinal cord injury. BJU Int 85:905–910
Lee KJ, Kim JH, Cho SW (2006) Short-term effects of magnetic sacral dermatome stimulation for idiopathic slow transit constipation: sham-controlled, cross-over pilot study. J Gastroenterol Hepatol 21:47–53
Morren GL, Walter S, Hallbook O, Sjodahl R (2001) Effects of magnetic sacral root stimulation on anorectal pressure and volume. Dis Colon Rectum 44:1827–1833
Gallas S, Gourcerol G, Ducrotte P, Mosni G, Menard JF, Michot F, Leroi AM (2009) Does magnetic stimulation of sacral nerve roots modify colonic motility? Results of a randomized double-blind sham-controlled study. Neurogastroenterol Motil 21:411–419
Tai C, Booth AM, de Groat WC, Roppolo JR (2001) Colon and anal sphincter contractions evoked by microstimulation of the sacral spinal cord in cats. Brain Res 889:38–48
Harris ML, Singh S, Rothwell J, Thompson DG, Hamdy S (2008) Rapid rate magnetic stimulation of human sacral nerve roots alters excitability within the cortico-anal pathway. Neurogastroenterol Motil 20:1132–1139
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kubota, M., Okuyama, N., Kobayashi, K. et al. Effects of neuromodulation with sacral magnetic stimulation for intractable bowel or bladder dysfunction in postoperative patients with anorectal malformation: a preliminary report. Pediatr Surg Int 27, 599–603 (2011). https://doi.org/10.1007/s00383-010-2839-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-010-2839-3