{"id":11214,"date":"2026-06-19T06:00:00","date_gmt":"2026-06-19T09:00:00","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=11214"},"modified":"2026-06-18T23:17:41","modified_gmt":"2026-06-19T02:17:41","slug":"neuromodulacao-sacral-na-incontinencia-fecal-indicacoes-e-abordagem-tecnica-parte-ii","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/neuromodulacao-sacral-na-incontinencia-fecal-indicacoes-e-abordagem-tecnica-parte-ii\/","title":{"rendered":"Neuromodula\u00e7\u00e3o Sacral na Incontin\u00eancia Fecal: Indica\u00e7\u00f5es e Abordagem T\u00e9cnica &#8211; Parte II"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/11214?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/11214?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\n<p>Na Parte I, foram discutidos os crit\u00e9rios de indica\u00e7\u00e3o, as contraindica\u00e7\u00f5es e a avalia\u00e7\u00e3o pr\u00e9-operat\u00f3ria dos candidatos \u00e0 neuromodula\u00e7\u00e3o sacral (<a href=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/neuromodulacao-sacral-na-incontinencia-fecal-indicacoes-e-abordagem-tecnica-parte-i\/\" type=\"link\" id=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/neuromodulacao-sacral-na-incontinencia-fecal-indicacoes-e-abordagem-tecnica-parte-i\/\">clique aqui para ler<\/a>). Nesta segunda parte, ser\u00e3o abordados os aspectos t\u00e9cnicos e as etapas do procedimento.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-descricao-da-tecnica-da-neuromodulacao-sacral-nms-padronizacao-e-precisao\"><strong>Descri\u00e7\u00e3o da T\u00e9cnica da Neuromodula\u00e7\u00e3o Sacral (NMS): Padroniza\u00e7\u00e3o e Precis\u00e3o<\/strong><\/h2>\n\n\n\n<p>A NMS \u00e9 um procedimento de <strong>dois est\u00e1gios<\/strong>: um <strong>teste de avalia\u00e7\u00e3o <\/strong>(avalia\u00e7\u00e3o percut\u00e2nea do nervo &#8211; PNE) e o <strong>implante definitivo<\/strong>. \u00c9 importante que seja realizada uma t\u00e9cnica padronizada de posicionamento do eletrodo para garantir a proximidade ideal com o nervo alvo, o que proporciona uma maior probabilidade de sucesso e menor possibilidade de efeitos adversos.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-preparacao-do-paciente-e-equipamento\"><br><strong>Prepara\u00e7\u00e3o do Paciente e Equipamento<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Posicionamento<\/strong>: dec\u00fabito ventral (Figura 1), com cabe\u00e7a, t\u00f3rax e quadris bem apoiados. Pelo menos quatro coxins s\u00e3o usados para suporte a fim de compensar a lordose lombar. Os p\u00e9s e podod\u00e1ctilos devem ser elevados da mesa (geralmente com uma almofada sob as pernas) para permitir a verifica\u00e7\u00e3o da resposta motora \u00e0 estimula\u00e7\u00e3o, como flex\u00e3o plantar do h\u00e1lux.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11217\"><img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"463\" data-id=\"11217\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Preparacao-do-paciente-1024x463.jpg?v=1779922201\" alt=\"\" class=\"wp-image-11217\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Preparacao-do-paciente-1024x463.jpg?v=1779922201 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Preparacao-do-paciente-300x136.jpg?v=1779922201 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Preparacao-do-paciente-768x347.jpg?v=1779922201 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Preparacao-do-paciente-585x265.jpg?v=1779922201 585w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Preparacao-do-paciente.jpg?v=1779922201 1037w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 1. Posicionamento do paciente. Acervo pessoal dos autores<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11218\"><img decoding=\"async\" width=\"530\" height=\"481\" data-id=\"11218\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-do-paciente.jpg\" alt=\"\" class=\"wp-image-11218\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-do-paciente.jpg?v=1779922377 530w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-do-paciente-300x272.jpg?v=1779922377 300w\" sizes=\"(max-width: 530px) 100vw, 530px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 1. Posicionamento do paciente. Acervo pessoal dos autores<\/figcaption><\/figure>\n<\/figure>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Observa\u00e7\u00e3o do \u00c2nus (Figura 2)<\/strong>: As n\u00e1degas devem ser afastadas com fita adesiva para permitir a visualiza\u00e7\u00e3o do \u00e2nus durante a eletroestimula\u00e7\u00e3o e verificar o movimento de \u201cbellows\u201d (contra\u00e7\u00e3o do assoalho p\u00e9lvico).<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11220\"><img decoding=\"async\" width=\"535\" height=\"406\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-e-afastamento-do-anus.jpeg\" alt=\"\" class=\"wp-image-11220\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-e-afastamento-do-anus.jpeg?v=1779923289 535w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-e-afastamento-do-anus-300x228.jpeg?v=1779923289 300w\" sizes=\"(max-width: 535px) 100vw, 535px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 2.<\/strong> Posicionamento e afastamento do \u00e2nus. Fonte: Acervo pessoal dos autores.<\/figcaption><\/figure>\n<\/div>\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Aterramento e Estimulador<\/strong>: Uma almofada de aterramento (\u201cfio terra\u201d) \u00e9 fixada ao paciente (ex: calcanhar) e conectada a um estimulador de teste externo (ENS, Verify\u00ae).<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-estagio-1-teste-de-avaliacao-teste-pne-percutaneous-nerve-evaluation-ou-teste-de-eletrodo-temporario\"><br><strong>Est\u00e1gio 1: Teste de Avalia\u00e7\u00e3o (Teste PNE &#8211; Percutaneous Nerve Evaluation ou Teste de Eletrodo Tempor\u00e1rio)<\/strong><\/h2>\n\n\n\n<p>Este est\u00e1gio \u00e9 importante para prever o sucesso a longo prazo da terapia.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-1-anestesia\"><strong>1.Anestesia<\/strong><\/h3>\n\n\n\n<p>Geralmente sob anestesia local e seda\u00e7\u00e3o leve.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-2-antibioticoprofilaxia\"><strong>2.Antibioticoprofilaxia<\/strong><\/h3>\n\n\n\n<p>Recomenda-se a administra\u00e7\u00e3o de uma dose intravenosa de antibi\u00f3tico profil\u00e1tico (ex.: cefazolina 2 g IV).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-3-identificacao-do-forame-sacral-e-marcacao-radiologica\"><strong>3.Identifica\u00e7\u00e3o do Forame Sacral e Marca\u00e7\u00e3o Radiol\u00f3gica<\/strong><\/h3>\n\n\n\n<p>Utiliza\u00e7\u00e3o de fluoroscopia em vista \u00e2ntero-posterior (AP) do sacro.<\/p>\n\n\n\n<p>Os par\u00e2metros radiol\u00f3gicos s\u00e3o as bordas mediais dos forames, marcadas com uma linha vertical de cada lado na pele, e uma linha conectando as bordas inferiores da articula\u00e7\u00e3o sacroil\u00edaca. Isso forma uma figura em &#8220;H&#8221;, cujos pontos de intersec\u00e7\u00e3o representam a parte medial superior do terceiro forame sacral, o local ideal para a entrada do eletrodo (Figura 3).<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11221\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"462\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Demarcacao-em-H-1024x462.jpg\" alt=\"\" class=\"wp-image-11221\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Demarcacao-em-H-1024x462.jpg?v=1779924292 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Demarcacao-em-H-300x135.jpg?v=1779924292 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Demarcacao-em-H-768x346.jpg?v=1779924292 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Demarcacao-em-H-585x264.jpg?v=1779924292 585w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Demarcacao-em-H-1080x487.jpg?v=1779924292 1080w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Demarcacao-em-H.jpg?v=1779924292 1104w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 3.<\/strong> Demarca\u00e7\u00e3o em H: delineamento vertical das margens mediais dos forames e linha horizontal indicativa da margem inferior da jun\u00e7\u00e3o \u00edleo-sacral. Fonte:(5)<\/figcaption><\/figure>\n\n\n\n<p>A individualidade anat\u00f4mica do sacro exige a orienta\u00e7\u00e3o por raio-X, pois a confian\u00e7a apenas em marcos \u00f3sseos superficiais pode levar a erros de posicionamento adequado da agulha no forame sacral de S3.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-4-posicionamento-da-agulha-do-forame\"><strong>4.Posicionamento da Agulha do Forame<\/strong><\/h3>\n\n\n\n<p>A agulha do forame (geralmente 9 cm, 20 Gauge) \u00e9 inserida em um ponto cef\u00e1lico \u00e0 marca\u00e7\u00e3o superficial de S3 (figura 5), estendendo-se de uma linha imagin\u00e1ria do bordo superior de S3 no \u00e2ngulo do plano de fus\u00e3o intervertebral S2-S3, de cerca de 60\u00ba com a pele e sendo introduzida paralelo ao eixo mediano, sem desvios mediais ou laterais.<\/p>\n\n\n\n<p>A progress\u00e3o da agulha no forame \u00e9 sentida como um movimento de penetra\u00e7\u00e3o atrav\u00e9s de uma estrutura ligamentar.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-5-teste-de-estimulacao-eletrica\"><strong>5.Teste de Estimula\u00e7\u00e3o El\u00e9trica<\/strong><\/h3>\n\n\n\n<p>Uma vez que a agulha atinge o n\u00edvel indicativo dentro do forame, a estimula\u00e7\u00e3o de teste \u00e9 realizada com o gerador de pulso externo (Figura 4). O objetivo \u00e9 obter uma resposta motora anal (contra\u00e7\u00e3o do assoalho p\u00e9lvico \u2013 \u201cbellows\u201d) e\/ou resposta dos podod\u00e1ctilos\/antep\u00e9 de flex\u00e3o, com uma corrente baixa, idealmente &lt;2 mA.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11222\"><img loading=\"lazy\" decoding=\"async\" width=\"664\" height=\"735\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-da-agulha.jpg\" alt=\"\" class=\"wp-image-11222\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-da-agulha.jpg?v=1779924694 664w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-da-agulha-271x300.jpg?v=1779924694 271w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Posicionamento-da-agulha-585x648.jpg?v=1779924694 585w\" sizes=\"(max-width: 664px) 100vw, 664px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 4<\/strong>. Posicionamento da agulha.<br>Fonte: Acervo pessoal dos autores<\/figcaption><\/figure>\n<\/div>\n\n\n<p>Com a estimula\u00e7\u00e3o, o cirurgi\u00e3o busca:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Resposta Motora: Contra\u00e7\u00e3o do assoalho p\u00e9lvico (movimento de &#8220;eleva\u00e7\u00e3o&#8221; do \u00e2nus), adu\u00e7\u00e3o da coxa ou dorsiflex\u00e3o do h\u00e1lux (reflexo pudendo).<\/li>\n\n\n\n<li>Resposta Sensorial: Parestesia ou sensa\u00e7\u00e3o de &#8220;formigamento&#8221; no per\u00edneo, escroto\/grandes l\u00e1bios ou regi\u00e3o retal\/vaginal.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-6-implante-do-eletrodo-permanente\"><strong>6.Implante do Eletrodo Permanente<\/strong><\/h3>\n\n\n\n<p>O eletrodo permanente de m\u00faltiplos polos (quadri polar) \u00e9 cuidadosamente inserido no mesmo forame sacral que demonstrou a melhor resposta, ap\u00f3s a substitui\u00e7\u00e3o da agulha pelo fio guia (t\u00e9cnica de Seldinger) e dilata\u00e7\u00e3o do trajeto com um introdutor inserido no forame sacral at\u00e9 sua marca radiopaca. O eletrodo permanente (Figura 5A) \u00e9 introduzido atrav\u00e9s do introdutor, sendo o principal objetivo posicionar os quatro contatos do eletrodo em estreita proximidade ao nervo sacral alvo, buscando uma resposta de estimula\u00e7\u00e3o adequada com &lt;2 mA em cada contato. A apar\u00eancia do eletrodo em vistas AP e lateral fluorosc\u00f3picas \u00e9 importante para confirmar o posicionamento ideal (Figuras 5B e C). A fixa\u00e7\u00e3o \u00e9 importante para evitar a migra\u00e7\u00e3o, sendo as farpas respons\u00e1veis por ancorar o eletrodo no tecido circundante.<\/p>\n\n\n\n<p><\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11223\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"447\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/figura-6-1024x447.jpg?v=1779928147\" alt=\"\" class=\"wp-image-11223\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/figura-6-1024x447.jpg?v=1779928147 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/figura-6-300x131.jpg?v=1779928147 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/figura-6-768x335.jpg?v=1779928147 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/figura-6-1170x510.jpg?v=1779928147 1170w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/figura-6-585x255.jpg?v=1779928147 585w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/figura-6-1080x471.jpg?v=1779928147 1080w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/figura-6.jpg?v=1779928147 1298w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 5.<\/strong> A) Eletrodo permanente B) Posicionamento adequado do eletrodo em AP na radioscopia. C) Posicionamento em perfil. Fonte: acervo pessoal dos autores.<\/figcaption><\/figure>\n<\/div>\n\n\n<h3 class=\"wp-block-heading\" id=\"h-7-remocao-do-introdutor\"><strong>7.Remo\u00e7\u00e3o do Introdutor<\/strong><\/h3>\n\n\n\n<p>Deve ser feita suavemente, sob fluoroscopia, para evitar o deslocamento do eletrodo. A posi\u00e7\u00e3o \u00e9 reconfirmada por estimula\u00e7\u00e3o e fluoroscopia.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-8-conexao-ao-gerador-externo\"><strong>8.Conex\u00e3o ao Gerador Externo<\/strong><\/h3>\n\n\n\n<p>O eletrodo permanente \u00e9 conectado a um gerador de pulso externo (Figura 6) que o paciente leva consigo por um per\u00edodo de 2 a 4 semanas. Durante este tempo, o paciente mant\u00e9m um di\u00e1rio de h\u00e1bitos intestinais (Figura 7).<\/p>\n\n\n\n<p>O teste \u00e9 considerado bem-sucedido se houver uma redu\u00e7\u00e3o de pelo menos 50% nos epis\u00f3dios de incontin\u00eancia fecal associado a uma melhora significativa na qualidade de vida percebida pelo paciente.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11246\"><img loading=\"lazy\" decoding=\"async\" width=\"683\" height=\"453\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Gerador-externo.jpeg\" alt=\"\" class=\"wp-image-11246\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Gerador-externo.jpeg?v=1779933177 683w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Gerador-externo-300x199.jpeg?v=1779933177 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Gerador-externo-585x388.jpeg?v=1779933177 585w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Gerador-externo-263x175.jpeg?v=1779933177 263w\" sizes=\"(max-width: 683px) 100vw, 683px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 6.<\/strong> Gerador externo &#8211; Fase teste. Fonte: Acervo pessoal dos autores<\/figcaption><\/figure>\n<\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11225\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"760\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Registro-de-Sintomas-Intestinais-1024x760.png\" alt=\"\" class=\"wp-image-11225\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Registro-de-Sintomas-Intestinais-1024x760.png 1024w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Registro-de-Sintomas-Intestinais-300x223.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Registro-de-Sintomas-Intestinais-768x570.png 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Registro-de-Sintomas-Intestinais-1170x868.png 1170w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Registro-de-Sintomas-Intestinais-585x434.png 585w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Registro-de-Sintomas-Intestinais-1080x801.png 1080w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Registro-de-Sintomas-Intestinais.png 1297w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 7.<\/strong> Registro de Sintomas Intestinais &#8211; o di\u00e1rio leva em considera\u00e7\u00e3o gravidade da urg\u00eancia evacuat\u00f3ria, escala de Bristol, n\u00famero de acidentes e quantidade de perdas. (Medtronic\u00ae)<\/figcaption><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\" id=\"h-estagio-2-implante-definitivo-do-sistema\"><strong>Est\u00e1gio 2: Implante Definitivo do Sistema<\/strong><\/h2>\n\n\n\n<p>Se o teste de avalia\u00e7\u00e3o for bem-sucedido, o paciente \u00e9 encaminhado para o implante definitivo.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Anestesia<\/strong>: Pode ser realizada sob anestesia local com seda\u00e7\u00e3o.<\/li>\n\n\n\n<li><strong>Profilaxia Antibi\u00f3tica<\/strong>: A profilaxia antibi\u00f3tica \u00e9 essencial para prevenir infec\u00e7\u00f5es, que podem levar \u00e0 remo\u00e7\u00e3o do implante. Recomenda-se uma dose intravenosa de antibi\u00f3ticos profil\u00e1ticos (ex: Cefazolina 2g IV) antes da implanta\u00e7\u00e3o. N\u00e3o h\u00e1 consenso sobre o benef\u00edcio do uso de campos impregnados com antibi\u00f3ticos, irriga\u00e7\u00e3o de feridas com solu\u00e7\u00e3o antibi\u00f3tica. Geralmente, n\u00e3o s\u00e3o necess\u00e1rios antibi\u00f3ticos p\u00f3s-operat\u00f3rios de rotina, embora alguns especialistas recomendem antibi\u00f3ticos orais de amplo espectro por cinco a sete dias.<\/li>\n\n\n\n<li><strong>Implante do Gerador de Pulso Implant\u00e1vel (IPG):<\/strong> O eletrodo permanente \u00e9 tunelizado pelo tecido celular subcut\u00e2neo e conectado a um IPG (um pequeno dispositivo eletr\u00f4nico com bateria). Este \u00e9 implantado em uma &#8220;bolsa&#8221; subcut\u00e2nea, geralmente na regi\u00e3o gl\u00fatea superior ou no abdome, ipsilateral \u00e0 inser\u00e7\u00e3o do eletrodo definitivo, em um local confort\u00e1vel e discreto para o paciente. O local do IPG deve ser 3-4 cm lateral ao osso sacral e 4-6 cm inferior \u00e0 crista il\u00edaca, evitando estruturas \u00f3sseas (Figura 8).<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11227\"><img loading=\"lazy\" decoding=\"async\" width=\"623\" height=\"468\" data-id=\"11227\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Localizacao-de-eletrodo-permanente.jpg\" alt=\"\" class=\"wp-image-11227\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Localizacao-de-eletrodo-permanente.jpg?v=1779929045 623w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Localizacao-de-eletrodo-permanente-300x225.jpg?v=1779929045 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Localizacao-de-eletrodo-permanente-585x439.jpg?v=1779929045 585w\" sizes=\"(max-width: 623px) 100vw, 623px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 8.<strong> <\/strong>Localiza\u00e7\u00e3o de eletrodo permanente. Fonte: Acervo pessoal dos autores<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11226\"><img loading=\"lazy\" decoding=\"async\" width=\"636\" height=\"477\" data-id=\"11226\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Localizacao-de-eletrodo-permanente-1.jpg\" alt=\"\" class=\"wp-image-11226\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Localizacao-de-eletrodo-permanente-1.jpg?v=1779929042 636w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Localizacao-de-eletrodo-permanente-1-300x225.jpg?v=1779929042 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Localizacao-de-eletrodo-permanente-1-585x439.jpg?v=1779929042 585w\" sizes=\"(max-width: 636px) 100vw, 636px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 8. Localiza\u00e7\u00e3o de eletrodo permanente. Fonte: Acervo pessoal dos autores<\/figcaption><\/figure>\n<\/figure>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Programa\u00e7\u00e3o e Acompanhamento:<\/strong> O IPG \u00e9 programado com par\u00e2metros de estimula\u00e7\u00e3o espec\u00edficos. Os pacientes recebem um controle remoto para ajustar a intensidade (Figura 9). Acompanhamentos regulares s\u00e3o necess\u00e1rios para otimizar a programa\u00e7\u00e3o e monitorar a resposta cl\u00ednica. A bateria do IPG tem uma vida \u00fatil em m\u00e9dia de 10 anos.<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11228\"><img loading=\"lazy\" decoding=\"async\" width=\"447\" height=\"381\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Dispositivo-de-controle-do-paciente-para-ajuste.jpeg\" alt=\"\" class=\"wp-image-11228\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Dispositivo-de-controle-do-paciente-para-ajuste.jpeg?v=1779929412 447w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/Dispositivo-de-controle-do-paciente-para-ajuste-300x256.jpeg?v=1779929412 300w\" sizes=\"(max-width: 447px) 100vw, 447px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 9.<\/strong> Dispositivo de controle do paciente para ajuste. Fonte: acervo pessoal dos autores.<\/figcaption><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\" id=\"h-resultados\"><br><strong>Resultados<\/strong><\/h2>\n\n\n\n<p><strong>Estudo multic\u00eantrico<\/strong> retrospectivo<sup>8<\/sup> conduzido em sete centros europeus avaliou os desfechos de longo prazo da neuromodula\u00e7\u00e3o sacral em 108 pacientes com IF ou dupla (urin\u00e1ria associada), com seguimento de at\u00e9 5 anos. Observou-se <strong>melhora significativa e sustentada dos sintomas<\/strong>, com redu\u00e7\u00e3o do escore de incontin\u00eancia de 15 para 2 em 12 meses e para 1 em 36 meses (p &lt; 0,0001), mantendo-se est\u00e1vel ao longo do acompanhamento. Al\u00e9m disso, <strong>houve melhora importante na qualidade de vida<\/strong> e todos os pacientes com disfun\u00e7\u00e3o sexual pr\u00e9via relataram resolu\u00e7\u00e3o dos sintomas ap\u00f3s 5 anos. A taxa de implante definitivo foi de 81,4%, refor\u00e7ando a efic\u00e1cia do m\u00e9todo.<\/p>\n\n\n\n<p><strong>Outra coorte retrospectiva multic\u00eantrica<\/strong> realizada em centros de cirurgia colorretal da Am\u00e9rica Latina<sup>15<\/sup> avaliou 131 pacientes com IF refrat\u00e1ria submetidos \u00e0 NMS, com seguimento mediano de 36,7 meses. Os resultados demonstraram <strong>melhora cl\u00ednica significativa<\/strong>, evidenciada pela redu\u00e7\u00e3o do escore CCF-FIS de 15,9 para 5,2 (p &lt; 0,0001), al\u00e9m de <strong>alta taxa de satisfa\u00e7\u00e3o<\/strong>, com 90% dos pacientes relatando melhora importante. A taxa de progress\u00e3o para implante definitivo foi elevada (98,5%), enquanto as complica\u00e7\u00f5es ocorreram em 14,7% dos casos, sendo em sua maioria manej\u00e1veis, e a taxa de remo\u00e7\u00e3o do dispositivo foi baixa (2,2%). <strong>Esses achados refor\u00e7am a efic\u00e1cia e a seguran\u00e7a da neuromodula\u00e7\u00e3o sacral, destacando sua aplicabilidade mesmo em contextos de pa\u00edses em desenvolvimento<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-complicacoes\"><strong>Complica\u00e7\u00f5es<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Dor<\/strong> <strong>no local do implante:<\/strong> Mais comum no in\u00edcio, mas geralmente transit\u00f3ria.<\/li>\n\n\n\n<li><strong>Infec\u00e7\u00e3o<\/strong>: Tanto no local do implante gerador quanto do eletrodo, podendo requerer explante do sistema, o que \u00e9 uma complica\u00e7\u00e3o grave.<\/li>\n\n\n\n<li><strong>Migra\u00e7\u00e3o do eletrodo<\/strong>: Pode levar \u00e0 perda de efic\u00e1cia e necessidade de revis\u00e3o cir\u00fargica para reposicionamento, um risco que a t\u00e9cnica padronizada busca mitigar.<\/li>\n\n\n\n<li><strong>Falha ou disfun\u00e7\u00e3o do dispositivo<\/strong>: Problemas com a bateria, o cabo ou o pr\u00f3prio gerador ocasionando disfun\u00e7\u00e3o do dispositivo como perda da estimula\u00e7\u00e3o eficaz, com necessidade de reprograma\u00e7\u00e3o e ajuste fino dos par\u00e2metros de estimula\u00e7\u00e3o.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-dispositivos-disponiveis-no-brasil\"><br><strong>Dispositivos Dispon\u00edveis no Brasil<\/strong><\/h2>\n\n\n\n<p>O sistema InterStim\u2122 X (Figura 10) \u00e9 um neuroestimulador que n\u00e3o necessita de recarga, compat\u00edvel com resson\u00e2ncia magn\u00e9tica e com vida \u00fatil da bateria superior a uma d\u00e9cada, podendo atingir at\u00e9 15 anos em configura\u00e7\u00f5es de baixo consumo energ\u00e9tico.<\/p>\n\n\n\n<p>InterStim\u2122 Micro (Figura 10) \u00e9 o menor dispositivo de neuromodula\u00e7\u00e3o sacral recarreg\u00e1vel (NMS) de 1,2 \u03a9, medindo 2,8ml. Possui dura\u00e7\u00e3o de bateria aproximada em 15 anos, entretanto necessita recargas semanais. O sistema InterStim\u2122 Micro, incluindo o eletrodo de resson\u00e2ncia magn\u00e9tica InterStim\u2122 SureScan\u2122, tamb\u00e9m possui rotulagem aprovada pela FDA para exames de resson\u00e2ncia magn\u00e9tica de corpo inteiro de 1,5 e 3 Tesla.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11229\"><img loading=\"lazy\" decoding=\"async\" width=\"901\" height=\"429\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/InterStim-X-e-InterStim-Micro.png\" alt=\"\" class=\"wp-image-11229\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/InterStim-X-e-InterStim-Micro.png 901w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/InterStim-X-e-InterStim-Micro-300x143.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/InterStim-X-e-InterStim-Micro-768x366.png 768w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/05\/InterStim-X-e-InterStim-Micro-585x279.png 585w\" sizes=\"(max-width: 901px) 100vw, 901px\" \/><\/a><figcaption class=\"wp-element-caption\"><br><strong>Figura 10.<\/strong> InterStim\u2122 X e InterStim\u2122 Micro, respectivamente. Fonte: Medtronic.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-conclusao\"><br><strong>Conclus\u00e3o<\/strong><\/h2>\n\n\n\n<p>A <strong>NMS representa uma op\u00e7\u00e3o valiosa e estabelecida no arsenal terap\u00eautico para pacientes com incontin\u00eancia fecal refrat\u00e1ria<\/strong>. O coloproctologista desempenha um papel fundamental na identifica\u00e7\u00e3o precoce desses pacientes, na otimiza\u00e7\u00e3o dos tratamentos conservadores e no encaminhamento oportuno para a avalia\u00e7\u00e3o de NMS.<\/p>\n\n\n\n<p>Uma abordagem multidisciplinar, envolvendo gastroenterologistas, coloproctologistas e urologistas (quando h\u00e1 incontin\u00eancia urin\u00e1ria associada), \u00e9 essencial para a sele\u00e7\u00e3o criteriosa dos pacientes, a realiza\u00e7\u00e3o bem-sucedida do procedimento, com \u00eanfase na t\u00e9cnica padronizada de implanta\u00e7\u00e3o e o acompanhamento a longo prazo. Essa colabora\u00e7\u00e3o garante resultados favor\u00e1veis e uma melhora significativa na qualidade de vida, restaurando a dignidade e a funcionalidade para aqueles que sofrem de IF.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-referencias\"><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Dawoud C, Reissig L, M\u00fcller C, Jahl M, Harpain F, Capek B, et al. Comparison of surgical techniques for optimal lead placement in sacral neuromodulation: a cadaver study. Tech Coloproctol. 2022;26(9):707-712. doi:10.1007\/s10151-022-02632-x.<\/li>\n\n\n\n<li>Rome Foundation. Rome V criteria [Internet]. Raleigh (NC): Rome Foundation; [cited 2026 Mar 8]. Available from:&nbsp;<a href=\"https:\/\/theromefoundation.org\/rome-iv\/rome-v-disorders-of-gut-brain-interaction-5th-edition\/\">https:\/\/theromefoundation.org\/rome-iv\/rome-v-disorders-of-gut-brain-interaction-5th-edition\/<\/a><\/li>\n\n\n\n<li>Rao SSC, Bharucha AE, Carrington EV, et al. Anorectal disorders. Gastroenterology. 2026;170(6):1318-1346.<\/li>\n\n\n\n<li>Lehur PA, Christoforidis D. Is anal sphincteroplasty out-dated in the era of sacral neuromodulation? J Visc Surg. 2020;157(1):1-2. doi:10.1016\/j.jviscsurg.2019.12.005.<\/li>\n\n\n\n<li>Matzel KE, Chartier-Kastler E, Knowles CH, Lehur PA, Mu\u00f1oz-Duyos A, Ratto C, et al. Sacral neuromodulation: standardized electrode placement technique. Neuromodulation. 2017;20(8):816-824. doi:10.1111\/ner.12695.<\/li>\n\n\n\n<li>Bittorf B, Matzel KE. Management of fecal incontinence: surgical treatment options. Visc Med. 2024;40(6):318-324. doi:10.1159\/000541355.<\/li>\n\n\n\n<li>Amend B, Matzel KE, Oerlemans D, van Kerrebroeck PE. How does sacral neuromodulation work? Neurourol Urodyn. 2011;30(5):762-765. doi:10.1002\/nau.21096.<\/li>\n\n\n\n<li>Brusciano L, Brillantino A, Pellino G, Marinello F, Baeten CI, Digesu A, et al. Sacral nerve modulation for patients with fecal incontinence: long-term outcome and effects on sexual function. Updates Surg. 2023;75(5):1187-1195. doi:10.1007\/s13304-023-01570-z.<\/li>\n\n\n\n<li>Ivatury SJ, Wilson LR, Paquette IM. Surgical treatment alternatives to sacral neuromodulation for fecal incontinence: injectables, sphincter repair, and colostomy. Clin Colon Rectal Surg. 2021;34(1):40-48. doi:10.1055\/s-0040-1714285.<\/li>\n\n\n\n<li>Katuwal B, Bhullar J. Current position of sacral neuromodulation in treatment of fecal incontinence. Clin Colon Rectal Surg. 2021;34(1):22-27. doi:10.1055\/s-0040-1714247.<\/li>\n\n\n\n<li>Salehi-Pourmehr H, Atayi M, Mahdavi N, Aletaha R, Kashtkar M, Sharifimoghadam S, et al. Is sacral neuromodulation effective and safe in pregnancy? A systematic review. Neurourol Urodyn. 2023;42(6):1329-1343. doi:10.1002\/nau.25224.<\/li>\n\n\n\n<li>Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77-97. doi:10.1007\/BF02050307.<\/li>\n\n\n\n<li>Yusuf SAI, Jorge JMN, Habr-Gama A, Kiss DR, Rodrigues JG. Avalia\u00e7\u00e3o da qualidade de vida na incontin\u00eancia anal: valida\u00e7\u00e3o do question\u00e1rio FIQL (Fecal Incontinence Quality of Life). Arq Gastroenterol. 2004;41(3):202-208. doi:10.1590\/S0004-28032004000300013.<\/li>\n\n\n\n<li>Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920-924. doi:10.3109\/00365529709011203.<\/li>\n\n\n\n<li>Oliveira L, Hagerman G, Torres ML, Lumi CM, Siachoque JAC, Reyes JC, et al. Sacral neuromodulation for fecal incontinence in Latin America: initial results of a multicenter study. Tech Coloproctol. 2019;23(6):545-550. doi:10.1007\/s10151-019-02004-y.<\/li>\n\n\n\n<li>Widmann B, Galata C, Warschkow R, Beutner U, \u00d6gredici \u00d6, Hetzer FH, et al. Success and complication rates after sacral neuromodulation for fecal incontinence and constipation: a single-center follow-up study. J Neurogastroenterol Motil. 2019;25(1):159-170. doi:10.5056\/jnm17106.<\/li>\n\n\n\n<li>Medtronic. InterStim X system [Internet]. Minneapolis (MN): Medtronic; [cited 2026 Mar 8]. Available from:&nbsp;<a href=\"https:\/\/www.medtronic.com\/en-us\/healthcare-professionals\/products\/bladder-bowel\/sacral-neuromodulation\/neurostimulators\/interstim-x-system.html\">https:\/\/www.medtronic.com\/en-us\/healthcare-professionals\/products\/bladder-bowel\/sacral-neuromodulation\/neurostimulators\/interstim-x-system.html<\/a><\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-como-citar-este-artigo\"><strong>Como citar este artigo<\/strong><\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Pinto RA, Lima AP, Neto IJF, Anjos LAP. Neuromodula\u00e7\u00e3o Sacral na Incontin\u00eancia Fecal: Indica\u00e7\u00f5es e Abordagem T\u00e9cnica \u2013 Parte II. Gastropedia 2026, Vol I. Dispon\u00edvel: <a href=\"https:\/\/gastropedia.pub\/pt\/?p=11214\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/gastropedia.pub\/pt\/gastroenterologia\/neuromodulacao-sacral-na-incontinencia-fecal-indicacoes-e-abordagem-tecnica-parte-2\/<\/a><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Na Parte I, foram discutidos os crit\u00e9rios de indica\u00e7\u00e3o, as contraindica\u00e7\u00f5es e a avalia\u00e7\u00e3o pr\u00e9-operat\u00f3ria dos candidatos \u00e0 neuromodula\u00e7\u00e3o sacral (clique aqui para ler). Nesta segunda parte, ser\u00e3o abordados os&hellip;<\/p>\n","protected":false},"author":5726,"featured_media":11221,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[24,26,18,22],"tags":[],"ano":[423],"tipo":[121],"volume":[57],"class_list":["post-11214","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cirurgia","category-colorretal","category-gastroenterologia","category-intestino","ano-423","tipo-assuntos-gerais","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Neuromodula\u00e7\u00e3o Sacral na Incontin\u00eancia Fecal: Indica\u00e7\u00f5es e Abordagem T\u00e9cnica - Parte II - Gastropedia<\/title>\n<meta name=\"description\" content=\"Entenda a t\u00e9cnica de 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