Transcutaneous sacral neurostimulation for irritative voiding dysfunction

with refractory irritative voiding dysfunction. Following an initial response, patients may successfully apply this treatment themselves to ensure long-term relief. Objective: Patients with irritative voiding dysfunction are often unresponsive to standard clinical treatment. We evaluated the response of such individuals to transcutaneous electrical stimulation of the third sacral nerve. Methods: 32 patients with refractory irritative voiding dysfunction (31 female and 1 male; mean age 47 years) were recruited to the study. Ambulatory transcutaneous electrical neurostimulation was applied bilaterally to the third sacral dermatomes for 1 week. Symptoms of frequency, nocturia, urgency, and bladder pain were scored by each patient throughout and up to 6 months following treatment. Results: The mean daytime frequency was reduced from 11.3 to 7.96 (p = 0.01). Nocturia episodes were reduced from a mean of 2.6 to 1.8 (p = 0.01). Urgency and bladder pain mean symptom scores were reduced from 5.97 to 4.89 and from 1.48 to 0.64, respectively. After stopping therapy, symptoms returned to pretreatment levels within 2 weeks in 40% of the patients and within 6 months in 100%, Three patients who continued with neurostimulation remained satisfied with this treatment modality at 6 months. Conclusions: Transcutaneous third sacral nerve stimulation may be an effective and noninvasive ambulatory technique for the treatment of patients with refractory irritative voiding dysfunction. Following an initial response, patients may successfully apply this treatment themselves to ensure long-term relief.

Non-invasive antidromic neurostimulation:A simple effective method for improving bladder storage

Patients with intractably diminished bladder storage function are encountered frequently by neurourologists, occasionally requiring reconstructive surgery for appropriate resolution. Although sacral neuromodulation is a recognized effective therapeutic modality, present techniques are technically demanding, invasive, and expensive. This study investigated the effect of non-invasive third sacral nerve (S3) stimulation on bladder activity during filling cystometry. One hundred forty-six patients underwent standard urodynamic filling cystometry that was then immediately repeated. Patients in the study group (n = 74) received antidromic transcutaneous sacral neurostimulation during the second fill and the control group (n = 72) underwent a second fill without neurostimulation. A statistically significant increase in bladder storage capacity without a corresponding rise in detrusor pressure was observed in the neurostimulated patients. This improvement in functional capacity is an encouraging finding that further supports the use of this non-invasive treatment modality in clinical practice. Neurourol. Urodynam. 20:73-84. 2001. (C) 2001 Wiley-Liss, Inc.

Navigating the Borderlands: Brian McGilloway as Contemporary Cartographer of the Liminal in the Ulster Landscape

Set in the borderlands between Letterkenny and Derry-Londonderry, a landscape scarred by geological fold, river and cartographer’s pen, the Ulster crime novelist Brian McGilloway chronicles the hopes and fears of a contemporary society unable to escape a complicated history, redolent and entwined with the voices of its ‘ghosts of its past.’ Through his choice of chief protagonist, An Garda Síochána officer Benedict Devlin, McGilloway turns detective to critically investigate the both the seemingly straightforward and the unseen dwelling in the rural Ulster landscape. Following in the footsteps of Nordic and Tartan Noir in making commentary on current societ,y McGilloway recognises the importance of the past in trying to reach an understanding of the present. His critique however goes beyond criminal behaviour motivated primarily by politics or religion, allowing a deeper and more meaningful diagnosis of the ‘state of the nation’. Place, name and event become especially important in contextualising the liminality of McGilloway’s real rural border settings. In doing so, McGilloway continues in the rich tradition of Ulster poet such as Heaney, MacNiece, Muldoon and Hewitt in trying to rationalise the man-made amidst the elemental in the land of both the ‘Planter & The Gael.’ History, language, tradition and the sacral are all instruments of investigation in helping McGilloway present a revealing pathology and atlas of our times to his readers. Turning literary investigator, the author contends that there is much to learn from this physiography, not just for the borderlands region, but for the wider countryside and society beyond. Keywords Cultural Atlas, Crime Fiction, Place, Poetry, Rural.