Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives

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Abstract

Objectives

This review describes the evidence from established and experimental therapies that use electrical nerve stimulation to treat lower urinary tract dysfunction.

Methods

Clinical studies on established treatments such as percutaneous posterior tibial nerve stimulation (P-PTNS), transcutaneous electrical nerve stimulation (TENS), sacral nerve stimulation (SNS) and sacral anterior root stimulation (SARS) are evaluated. In addition, clinical evidence from experimental therapies such as dorsal genital nerve (DGN) stimulation, pudendal nerve stimulation, magnetic nerve stimulation and ankle implants for tibial nerve stimulation are evaluated.

Results

SNS and P-PTNS have been investigated with high-quality studies that have shown proven efficacy for the treatment for overactive bladder (OAB). SARS has proven evidence-based efficacy in spinal cord patients and increases the quality of life. TENS seems inferior to other OAB treatments such as SNS and P-PTNS but is noninvasive and applicable for ambulant therapy. Results from studies on experimental therapies such as pudendal nerve stimulation seem promising but need larger study cohorts to prove efficacy.

Conclusion

Neurostimulation therapies have proven efficacy for bladder dysfunction in patients who are refractory to other therapies.

Significance

Refinement of neurostimulation therapies is possible. The aim should be to make the treatments less invasive, more durable and more effective for the treatment of lower urinary tract dysfunction.

Related collections

Most cited references 59

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Urinary bladder contraction and relaxation: physiology and pathophysiology.

Anders Arner, Karl Andersson (2004)

The detrusor smooth muscle is the main muscle component of the urinary bladder wall. Its ability to contract over a large length interval and to relax determines the bladder function during filling and micturition. These processes are regulated by several external nervous and hormonal control systems, and the detrusor contains multiple receptors and signaling pathways. Functional changes of the detrusor can be found in several clinically important conditions, e.g., lower urinary tract symptoms (LUTS) and bladder outlet obstruction. The aim of this review is to summarize and synthesize basic information and recent advances in the understanding of the properties of the detrusor smooth muscle, its contractile system, cellular signaling, membrane properties, and cellular receptors. Alterations in these systems in pathological conditions of the bladder wall are described, and some areas for future research are suggested.

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Descending modulation of pain.

G F Gebhart (2003)

Although interest in descending modulation of spinal cord function dates back to the time of Sherrington, the modern era began in the late 1960s when it was shown that focal electrical stimulation in the midbrain of the rat produced analgesia sufficient to permit surgery. From this report evolved the concept of endogenous systems of pain modulation. Initial interest focused on descending inhibition of spinal nociceptive processing, but we now know that descending modulation of spinal nociceptive processing can be either inhibitory or facilitatory. As our understanding of descending facilitatory, or pro-nociceptive influences grows, so too has our appreciation of its potential importance. Accumulating evidence suggests that descending facilitatory influences may contribute to the development and maintenance of hyperalgesia and thus contribute to chronic pain states.

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Overactive bladder significantly affects quality of life.

Candace Kerr, Thomas R. Rogers, Murray Abrams … (2000)

Overactive bladder (OAB), with symptoms of frequency, urgency, and urge incontinence, substantially affects the lives of millions of people. The symptoms associated with OAB can significantly affect the social, psychological, occupational, domestic, physical, and sexual aspects of those who suffer from it. Unfortunately, many sufferers are reluctant to discuss their condition with their healthcare provider or family members. As a result, OAB remains underreported, despite increased awareness and improved diagnosis and treatment. Health-related quality of life can be measured objectively, and several instruments have been developed, validated, and used in research. Currently, there are 2 major types of quality-of-life questionnaires: generic and disease specific. Although these questionnaires have been helpful and are widely used, the goal is to establish a single questionnaire that is acceptable throughout the world for use by urologists, gynecologists, urogynecologists, geriatricians, and epidemiologists.

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Author and article information

Journal

Journal ID (nlm-ta): Med Devices (Auckl)

Journal ID (iso-abbrev): Med Devices (Auckl)

Journal ID (publisher-id): Medical Devices: Evidence and Research

Title: Medical Devices (Auckland, N.Z.)

Publisher: Dove Medical Press

ISSN (Electronic): 1179-1470

Publication date Collection: 2017

Publication date (Electronic): 01 June 2017

Volume: 10

Pages: 109-122

Affiliations

[1 ]Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen

[2 ]Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands

Author notes

Correspondence: Dick AW Janssen, Department of Urology, Radboud University Nijmegen Medical Center, Geert Grootteplein 10, 6500 HB, Nijmegen, the Netherlands, Email dick.janssen@ 123456radboudumc.nl

Article

Publisher ID: mder-10-109

DOI: 10.2147/MDER.S115678

PMC ID: 5460621

SO-VID: 197c1200-f01b-4b03-941e-c3fcfd125067

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives

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Abstract

Objectives

Methods

Results

Conclusion

Significance

Related collections

Genome Engineering using CRISPR

Most cited references 59

Urinary bladder contraction and relaxation: physiology and pathophysiology.

Descending modulation of pain.

Overactive bladder significantly affects quality of life.

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