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Pelvic Floor Neuromodulation in Neurologic Patients

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Electrical Stimulation for Pelvic Floor Disorders

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Abstract

Patients with lesions above the pons usually continue to have reflex contractions of the detrusor, but the cerebral regulation of voiding and defecation is often lost. This is the case in lesions as from stroke, head injury, etc., which mostly continue to have a normal coordinated sphincteric function. However these patients may purposely increase sphincter activity during an overactive detrusor contraction to prevent urinary incontinence which would otherwise occur. This has been termed “pseudo-dyssynergia” because it is indistinguishable from true dyssynergia on a urodynamic record. Urinary incontinence in suprapontine lesions, such as stroke, Parkinson’s disease, and multiple sclerosis, is due to bladder overactivity.

Most frequent suprasacral lesions are spinal cord injury and multiple sclerosis. A spinal cord injury (SCI) is damage or trauma to the spinal cord that results in a loss or impaired function causing reduced mobility or feeling. Common causes of damage are trauma (car accident, gunshot, falls, sports injuries, etc.) or disease (transverse myelitis, poliomyelitis, spina bifida, Friedreich’s ataxia, etc.). In SCI, bowel and bladder dysfunctions have significant lifelong consequences, and neurogenic voiding dysfunction is a major contributor to the morbidity and mortality.

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Authors and Affiliations

  1. Neuro-Urology Department, AOU Careggi University Hospital, Largo Palagi 1, Florence, Italy

    Giulio Del Popolo & Stefania Musco

  2. Pelvic Floor Center, Ercole Franchini Hospital, Montecchio Emilia, Italy

    Jacopo Martellucci

  3. General, Emergency and Minimally Invasive Surgery, AOU Careggi University Hospital, Largo Brambilla 3, Florence, 50134, Italy

    Jacopo Martellucci

  4. University of Siena, Siena, Italy

    Jacopo Martellucci

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  1. Giulio Del Popolo
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  2. Jacopo Martellucci
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  3. Stefania Musco
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Correspondence to Giulio Del Popolo .

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  1. General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy

    Jacopo Martellucci

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Del Popolo, G., Martellucci, J., Musco, S. (2015). Pelvic Floor Neuromodulation in Neurologic Patients. In: Martellucci, J. (eds) Electrical Stimulation for Pelvic Floor Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-06947-0_19

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  • DOI: https://doi.org/10.1007/978-3-319-06947-0_19

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