Effects of neuromodulation with sacral magnetic stimulation for intractable bowel or bladder dysfunction in postoperative patients with anorectal malformation: a preliminary report.
OBJECTIVE
The effects of neuromodulation with sacral magnetic stimulation (SMS) were examined in postoperative patients with bowel or bladder dysfunction.


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.
Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan. mkubota@med.niigata-u.ac.jp
Masayuki
M
Kubota
Naoki
N
Okuyama
Kumiko
K
Kobayashi
Mami
M
Tsukada
Kengo
K
Nakaya
Miki
M
Ishikawa
D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D002675:Child, Preschool; D003248:Constipation / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D055909:Magnetic Field Therapy / Q000379:methods*; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D011860:Radiography, Abdominal; D012445:Sacrococcygeal Region; D016055:Urinary Retention / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D014567:Urography
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