| Popis: |
The effect of the Brindley stimulator on pelvic floor function has been studied in seven paraplegic subjects by standard manometric, radiologic, and electrophysiologic methods. There was no difference in the maximum resting pressure in the anal canal between the stimulated group and paraplegic subjects without sacral stimulators acting as controls. The fall in pressure in response to the rectosphinteric reflex as a percentage of the original resting pressure was significantly less, indicating a proportional effect on the external sphincter. There was less descent of the pelvic floor at rest in the stimulated group, but no difference in the pudendoanal reflex latency, motor unit potential duration, or resting electromyogram activity of the external anal sphincter. The maximum resting pressure in the anal canal, the pudendoanal reflex response amplitude, and the external anal sphincter electromyogram activity increased, however, with the duration of the implant. The S4 root had the dominant effect on the pelvic floor, with decreasing effects from the S3 and S2 roots on the pressure and integrated electromyogram activity generated by the external anal sphincter. The anorectal angle had not changed at rest in the group with the stimulator, but S4 root stimulation made it more acute than S3 or S2 root stimulation. The results suggest profound effects of S4 anterior root stimulation on the pelvic floor with additional effects of S3 and S2 anterior roots on pelvic function. |
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