ABSTRACT
AIMS: The objective of this study was to investigate sacral electrical stimulation (SES) and gastric electrical stimulation (GES) by comparing upper and lower gastrointestinal (GI) and genitourinary (GU) symptoms and quality of life, before treatment and in the long term after treatment. We hypothesized that dual-device treatment would greatly improve upper and lower gastrointestinal and genitourinary symptoms, as well as quality of life. METHODS: Fifty-four patients who underwent dual-device treatment (GES and SES) were enrolled in this study. Patients who had surpassed 24 months since the second-device insertion were included. Patients were evaluated before and after both devices were implanted and given a symptom questionnaire regarding their upper GI, lower GI, and GU symptoms and their quality of life. RESULTS: With combined treatment, a statistically significant improvement was seen in upper GI, lower GI, and GU symptoms and quality of life. However, fecal incontinence and fecal urgency improvements did not reach statistical significance, likely due to the small sample size. CONCLUSION: The implantation of two stimulators appears to be safe and effective to improve patients' quality of life for those with upper GI symptoms, bowel problems, and bladder dysfunction.
Subject(s)
Electric Stimulation Therapy/instrumentation , Electrodes, Implanted , Fecal Incontinence/therapy , Gastroparesis/therapy , Intestines/innervation , Lumbosacral Plexus/physiopathology , Stomach/innervation , Urinary Bladder/innervation , Urinary Incontinence/therapy , Adult , Defecation , Equipment Design , Fecal Incontinence/diagnosis , Fecal Incontinence/physiopathology , Female , Follow-Up Studies , Gastric Emptying , Gastroparesis/diagnosis , Gastroparesis/physiopathology , Humans , Male , Quality of Life , Recovery of Function , Retrospective Studies , Surveys and Questionnaires , Time Factors , Treatment Outcome , United States , Urinary Incontinence/diagnosis , Urinary Incontinence/physiopathology , UrodynamicsABSTRACT
Sacral colpopexy is often chosen as a reliable approach that effectively resolves vaginal vault prolapse. Advancements in minimally invasive technology, robotic and laparoscopic surgery, have helped facilitate surgical dissection and operation when performing this procedure. An increased presacral thickness can potentially present a surgical challenge when operating in the presacral space. We hypothesize that there is a correlation between body mass index and presacral thickness. Computed Tomography (CT) images of 241 patients were reviewed in this retrospective study. The presacral thickness was measured by taking the cross sectional distance from the sacral promontory to the upper aspect of the iliac arteries. The corresponding demographic information of age, body mass index (BMI), and comorbidities were evaluated using univariate analysis, linear regression, and multiple regression analysis. The mean age was 56.6 years, and BMI was 27.6. The mean presacral thickness measurement based on the CT scan was 21.08 mm. Univariate linear regression models demonstrated a positive correlation between presacral thickness and BMI and a negative correlation with age. When adjusting for both age and BMI on multivariate analysis, a positive correlation with hypertension was found. The surgeon should be aware of this potential change in anatomy when operating in the presacral space.
