RESUMEN
INTRODUCTION AND HYPOTHESIS: The objective of this video is to describe the technique for laparoscopic implantation of electrodes for bilateral neuromodulation of S3 and pudendal nerves. We report a successful case of a 48-year-old woman with spina bifida occulta referred with a 14-year history of intense acyclic pelvic pain, urinary hesitancy, and intermittent flow refractory to various conservative measures. METHODS: The procedure began with the removal of two previously placed InterStims. A quadripolar electrode was then laparoscopically inserted into Alcock's canal and attached to the pelvic pectineal line. Another lead was placed juxtaneurally to S3. Lead contacts were then exteriorized, and the peritoneum closed. The same procedure was then performed on the contralateral side. The leads were connected to a 16-pole rechargeable pulse generator. Postoperatively, the patient developed an acute dissection and partial thrombosis of the external iliac artery, which was treated endovascularly. RESULTS: Complete pain resolution was observed with simultaneous S3 and pudendal stimulation, with pudendal stimulation turned off for voiding. CONCLUSIONS: We conclude that laparoscopic implantation of neuromodulation electrodes allows simultaneous stimulation of S3 and pudendal nerves, providing more programming options and possibly increasing success rates in complex pelvic floor dysfunction cases.
Asunto(s)
Terapia por Estimulación Eléctrica , Electrodos Implantados , Laparoscopía , Diafragma Pélvico , Dolor Pélvico/terapia , Nervio Pudendo , Incontinencia Urinaria/terapia , Animales , Femenino , Humanos , Ratones , Persona de Mediana Edad , Diafragma Pélvico/anatomía & histología , Diafragma Pélvico/inervación , Resultado del Tratamiento , Vejiga Urinaria/inervaciónRESUMEN
INTRODUCTION: Self-esteem and self-image are psychological aspects that affect sexual function. AIMS: To validate a new measurement tool that correlates the concepts of self-esteem, self-image, and sexuality. METHODS: A 20-question test (the self-esteem/self-image female sexuality [SESIFS] questionnaire) was created and tested on 208 women. Participants answered: Rosenberg's self-esteem scale, the female sexual quotient (FSQ), and the SESIFS questionnaire. Pearson's correlation coefficient was used to test concurrent validity of the SESIFS against Rosenberg's self-esteem scale and the FSQ. Reliability was tested using the Cronbach's alpha coefficient. RESULT: The new questionnaire had a good overall reliability (Cronbach's alpha r = 0.862, p < 0.001), but the sexual domain scored lower than expected (r = 0.65). The validity was good: overall score r = 0.38, p < 0.001, self-esteem domain r = 0.32, p < 0.001, self-image domain r = 0.31, p < 0.001, sexual domain r = 0.29, p < 0.001. CONCLUSIONS: The SESIFS questionnaire has limitations in measuring the correlation among self-esteem, self-image, and sexuality domains. A new, revised version is being tested and will be presented in an upcoming publication.