<p>Spinal cord injury (SCI) and other neurological diseases and disorders can cause urinary dysfunction that can cause serious health problems and reduce an individual's quality of life. Current methods for treating urinary dysfunction have major limitations or provide inadequate improvement in urinary symptoms. Pudendal nerve stimulation is a potential means of restoring control of bladder function in persons with neurological disease or spinal cord injury. Bladder contraction and relaxation can be evoked by pudendal afferent stimulation, and peripheral pudendal afferent branches may be ideal targets for a bladder control neural prosthesis. This dissertation investigates control of bladder function by selective activation of pudendal afferents.</p> <p>This study investigated the ability to improve both urinary continence and micturition by both direct and minimally-invasive electrical stimulation of selected pudendal afferents in &#945;-chloralose anesthetized male cats. Direct stimulation of the pudendal afferents in the dorsal nerve of the penis (DNP), percutaneous DNP stimulation, and intraurethral stimulation were used to investigate the bladder response to selective activation of pudendal afferents. Finite element modeling of the cat lower urinary tract was used to investigate the impact of intraurethral stimulation location and intraurethral electrode configuration on activation of pudendal afferents. Also, the impact of pharmacological and surgical block of sympathetic activity to the bladder on the bladder reflexes evoked by DNP stimulation was investigated to determine the role of the sympathetic bladder innervation on the mechanism of bladder activation by pudendal afferent stimulation.</p> <p>The DNP is an ideal target for restoring urinary function because stimulation at low frequencies (5-10 Hz) improves urinary continence, while stimulation at high frequencies (33-40 Hz) improves urinary voiding. Intraurethral stimulation is a valid method for clinical investigation of the ability to evoke bladder inhibition and activation via selective activation of the DNP or cranial sensory branch (CSN) of the pudendal nerve. In the cat, intraurethral stimulation can activate the bladder via two distinct neural pathways, a supraspinal pathway reflex activated by the CSN and a spinal reflex activated by the DNP. Finite element modeling revealed the importance of urethral location for selective pudendal afferent activation by intraurethral stimulation. Finally, the sympathetic bladder pathway does not play a significant role in the mechanism mediating bladder activation by DNP stimulation. These findings imply that selective pudendal afferent stimulation is a promising approach for restoring control of bladder function to individuals with SCI or other neurological disorders.</p> / Dissertation

Knowledge of the course of the pudendal nerve (PN) is important when performing perineal surgery. Distances between landmarks were measured after PN dissections in 71 cadavers and after perineal procedures on 30 cadavers. Separate inferior rectal nerve (IRN) entry and medial position of the PN/IRN with shortened sacrospinous ligaments were often seen in black individuals. A PN block should therefore be placed more proximally and medially. The Richter’s stitch should be placed further from the ischial spine. During ischioanal procedures the IRN is at risk in white females, as it was more superficial. The dorsal nerve of the clitoris/penis (DNC/DNP) is in danger during the outside-in procedures in white or obese individuals, as it was closer to the inferior pubic ramus. The dorsal penile nerve block should be administered deeper in white and obese individuals, as the DNP was deeper. The above-mentioned findings should be verified in a clinical setting. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Anatomy / Unrestricted

Bakgrund: Inom förlossningsvården används en typ av bedövning kallad pudendusblockad (PDB). Denna bedövning kan administreras på två olika sätt; antingen genom så kallad inre eller yttre teknik. Den yttre tekniken introducerades 2015, dess praktiska för- och nackdelar är ännu inte utförligt dokumenterade i litteraturen.  Syfte: Att utforska barnmorskors erfarenheter av yttre pudendusblockad vid inspektion och suturering postpartum.  Metod: Studien genomfördes med en kvalitativ design. Insamlad data består av intervjuer från totalt tio barnmorskor från två sjukhus i södra Sverige. Dataanalysen genomfördes med kvalitativ innehållsanalys.  Resultat: Resultaten av studien indikerar bland annat att yttre PDB är en uppskattad bedövningsteknik i regionerna, de intervjuade barnmorskorna angav att de använde yttre PDB i majoriteten av alla förlossningar. Över lag var också samtliga deltagare positiva till bedövningen; den upplevs framför allt som en säker smärtlindring, lätt att administrera och kvinnorna ansågs väl bedövade inför suturering. Några väsentliga negativa aspekter kunde enligt deltagarna ej påvisas.  Slutsats: Yttre PDB är en uppskattad bedövningsform som används i stor utsträckning på båda sjukhusen. / Background: Pudendal nerve block (PNB) is a common anesthetic used in maternity care. This anesthesia can be administered in two different ways; either through the so-called inner or outer technique. The outer technique introduces 2015, its practical pros and cons have not yet been thoroughly described in literature.  Purpose: To explore midwives experiences of outer pudendal nerve block during inspection and suturing after delivery.  Method: The study is conducted with a qualitative design. Collected data consists of interviews from a total of ten midwives from two hospitals in southern Sweden. Data has been analyzed with qualitative content analysis. Result: The results of the study indicate for instance that outer PNB is an appreciated technique for anesthesia in the examined geographical region, the interviewees stated that they use outer PNB in the majority of all cases. Furthermore, every interviewee was positive towards the treatment; most importantly, it is viewed as a safe method, easy to administer and patients are well anaesthetized for suturing. No primary negative aspect could be concluded from the interviews.  Conclusion: Outer PNB is an appreciated technique that is used to a large extent at the hospitals surveyed in this study.

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