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      Neuromodulation in neurogenic bladder

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          Abstract

          While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction.

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          Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury.

          Karl-Dietrich Sievert, Bastian Amend, G. Gakis … (2010)
          The study aim was to investigate potential influences on human nerves and pelvic organs through early implantation of bilateral sacral nerve modulators (SNMs) in complete spinal cord injury (SCI) patients during the acute bladder-areflexia phase.
          Article 0 comments Cited 37 times – based on 0 reviews     Review now
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            Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study.

            F GOVIER, S Litwiller, V W Nitti … (2001)
            More than 20 million Americans have an overactive bladder, the predominant symptoms being frequency, urgency, urge incontinence and pelvic pain. While the etiology is not completely understood, most investigators believe the causes to be many and the pelvic floor to be intimately related. Whatever the etiology, traditional therapies, including dietary manipulation, bladder drill, medications and physical therapy, are often poorly tolerated and/or ineffective. We report a prospective, multicenter clinical trial that was undertaken to determine the safety and efficacy of percutaneous peripheral afferent nerve stimulation for treatment of refractive overactive bladder and/or pelvic floor dysfunction. A total of 53 patients with overactive bladders, in whom all traditional therapy failed, were enrolled in 1 of 5 sites within the United States. Patients received weekly percutaneous electrical stimulations via a 34 gauge needle placed near the tibial nerve 3 finger breadths above the ankle. Urodynamic studies, detailed voiding diaries, quality of life surveys, and incontinence impact questionnaires were completed before, during and after the study. Of the patients with a mean age of 57.4 years 89% (47 of 53) completed the 12-week study. A total of 71% of patients were classified as treatment successes by the investigators and were started on long-term treatment. On average patients noticed a 25% reduction in mean daytime and 21% reduction in mean nighttime voiding frequencies (p <0.05). Urge incontinence was reduced by an average of 35% (p <0.05). Statistically significant improvements were noted in selective pain and quality of life indexes. No significant adverse events related to treatment were noted in any patients. Percutaneous peripheral afferent nerve stimulation offers a safe, minimally invasive and effective treatment for managing refractive overactive bladder and/or pelvic floor dysfunction.
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              Efficacy and safety of sacral nerve stimulation for urinary urge incontinence: a systematic review.

              Miriam Brazzelli, Alison Murray, Cynthia Fraser (2006)
              We systematically reviewed the evidence on the efficacy and safety of sacral nerve stimulation (SNS) for severe urge incontinence. A systematic review was performed of primary studies of SNS for urge incontinence published in English between 1966 and May 2003, and identified in major electronic databases. Two reviewers independently selected studies, assessed their methodological quality and extracted data. Four randomized controlled trials and 30 case series were identified. Evidence from the randomized controlled trials, involving approximately 120 patients, showed that about 80% achieved continence or greater than 50% improvement in their main incontinence symptoms after SNS compared with about 3% of controls receiving conservative treatments while waiting for an implant. While case series were larger, they were methodologically less reliable. However, they showed similar results with 67% of patients becoming dry or achieving a greater than 50% improvement in symptoms after implantation. Incontinence episodes, leakage severity, voiding frequency and pad use were significantly lower after implantation. Benefits were reported to persist 3 to 5 years after implantation. Adverse events were documented in 27 studies. Overall the reoperation rate in implanted cases was 33%. The most common reason for surgical revision was relocation of the generator because of pain and infection. Common complications were pain at the implant or lead site in 25% of patients, lead related problems such as lead migration in 16%, replacement and repositioning of the implanted pulse generator in 15%, wound problems in 7%, adverse effects on bowel function in 6%, infection in 5% and generator problems in 5%. Permanent removal of the electrodes was reported in 9% of patients. Technical changes with time have been associated with decreased complication rates. There is evidence indicating that SNS is effective for decreasing symptoms in patients with urge incontinence. Adverse events occurred in about half of the implanted cases and surgical revision was performed in 33%. No major irreversible complications were reported in the studies reviewed. Further research is required on the long-term effects of and quality of life in patients with SNS.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Transl Androl Urol
                Journal ID (iso-abbrev): Transl Androl Urol
                Journal ID (publisher-id): TAU
                Title: Translational Andrology and Urology
                Publisher: AME Publishing Company
                ISSN (Electronic): 2223-4691
                Publication date (Print and electronic): February 2016
                Publication date (Print): February 2016
                Volume: 5
                Issue: 1
                Pages: 117-126
                Affiliations
                [1]Department of Urology, University of California, San Francisco, CA, USA
                Author notes

                Contributions: (I) Conception and design: All authors; (II) Administrative support: AM Suskind; (III) Provision of study materials or patients: MT Sanford; (IV) Collection and assembly of data: MT Sanford; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Anne M. Suskind. Department of Urology, 400 Parnassus Ave, San Francisco, CA 94143, USA. Email: Anne.Suskind@ 123456ucsf.edu .
                Article
                Publisher ID: tau-05-01-117
                DOI: 10.3978/j.issn.2223-4683.2015.12.01
                PMC ID: 4739974
                PubMed ID: 26904417
                SO-VID: 8d0cf84c-3499-4195-adb3-03388424489a
                Copyright © 2016 Translational Andrology and Urology. All rights reserved.
                History
                Date received : 15 September 2015
                Date accepted : 05 December 2015
                Categories
                Subject: Review Article

                Keywords: neurogenic bladder,implantable neurostimulators
                Data availability:
                Keywords: neurogenic bladder, implantable neurostimulators

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