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KÜTÜKOĞLU U, ALTUNTAŞ T, ŞAHİN B, ONUR R. Sacral neuromodulation treatment for urinary voiding dysfunctions: results of treatment with the largest single-center series in a tertiary referral center in Turkey. Turk J Med Sci 2023; 53:206-210. [PMID: 36945940 PMCID: PMC10387836 DOI: 10.55730/1300-0144.5575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/22/2023] [Accepted: 03/19/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Sacral neuromodulation (SNM) is a minimally invasive treatment that modulates spinal reflexes to regulate bladder, urinary sphincter, and pelvic floor and has successfully been used in the treatment of refractory voiding dysfunctions. The aim of this study was to present our experience with SNM in a tertiary referral center with the largest number of patients and review the safety and efficacy of the procedure. METHODS A total of 42 patients with refractory lower urinary tract symptoms were included into the study. After an initial test period, patients who showed more than 50% improvement in their symptoms underwent the second stage of SNM. Twelve patients had overactive bladder (OAB), bladder pain syndrome/interstitial cystitis (BPS/IC) and 17 had urinary retention. The clinical success was examined during follow-up by voiding diary, urodynamics, and global response assessment. RESULTS Between February 2015 and December 2020, a total of 29 patients underwent stages I&II SNM procedures. The mean ages of patients in OAB/BPS group and retention group were 40 (37-57 years) and 35 (27-44 years), respectively. Mean follow-up time was at least 1 year. Overall, 58.5% success rate was observed in OAB, BPS/IC, and urinary retention groups. Global response assessment score in both groups increased significantly (p = 0.001). No statistically significant difference was found between success or failure rates when sex and age were variable parameters (p > 0.05). DISCUSSION SNM appears to be an effective and safe treatment option in restoring voiding dysfunctions in patients with refractory idiopathic and neurogenic voiding dysfunctions. Our initial series revealed favorable results; however, further studies with larger series and longer follow-up are needed.
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Affiliation(s)
- Umut KÜTÜKOĞLU
- Department of Urology, Faculty of Medicine, Marmara University, İstanbul,
Turkey
| | - Türker ALTUNTAŞ
- Department of Urology, Faculty of Medicine, Marmara University, İstanbul,
Turkey
| | - Bahadır ŞAHİN
- Department of Urology, Faculty of Medicine, Marmara University, İstanbul,
Turkey
| | - Rahmi ONUR
- Department of Urology, Faculty of Medicine, Marmara University, İstanbul,
Turkey
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Padilla-Fernández B, Hernández-Hernández D, Castro-Díaz DM. Current role of neuromodulation in bladder pain syndrome/interstitial cystitis. Ther Adv Urol 2022; 14:17562872221135941. [PMID: 36438605 PMCID: PMC9685149 DOI: 10.1177/17562872221135941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/06/2022] [Indexed: 09/22/2023] Open
Abstract
Neuromodulation is recommended by major international guidelines as a fourth-line treatment in bladder pain syndrome/interstitial cystitis (BPS/IC) patients after failure of behavioural, oral and intravesical pharmacological treatments, including hydrodistension. A non-systematic review of studies identified by electronic search of MEDLINE was performed with no time limitation. A narrative synthesis of the existing evidence regarding the results of sacral, tibial and pudendal nerve stimulation in the management of BPS/IC was developed. Neuromodulation in pelvic chronic pain disorders, including BPS/IC, is a useful tool for refractory patients to conventional treatments. Sacral neuromodulation may be effective in patients with BPS without Hunner's lesions, and the effect seems to be maintained in the mid- and long-term. Posterior tibial nerve stimulation can be offered to patients with BPS/IC in the context of a multidisciplinary approach. When pudendal neuralgia is suspected, selective pudendal nerve stimulation has a high response rate. The aetiology of the pain can influence the outcomes in the mid- and long-term of the different neuromodulation approaches, thus careful diagnosis is recommended.
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Affiliation(s)
- Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario
Universitario de Canarias, Carretera La Cuesta, s/n, San Cristóbal de La
Laguna 38320, Tenerife, Spain
- Departamento de Cirugía, Facultad de Medicina,
Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - David Hernández-Hernández
- Department of Urology, Complejo Hospitalario
Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - David M. Castro-Díaz
- Department of Urology, Complejo Hospitalario
Universitario de Canarias, San Cristóbal de La Laguna, Spain
- Departamento de Cirugía, Facultad de Medicina,
Universidad de La Laguna, San Cristóbal de La Laguna, Spain
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Long-term Outcomes of Sacral Nerve Stimulation in Pelvic Floor Dysfunctions. Int Neurourol J 2021; 25:319-326. [PMID: 33504121 PMCID: PMC8748304 DOI: 10.5213/inj.2040364.182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/23/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose The aim of this study was to analyze the long-term outcomes of sacral nerve stimulation (SNS) in both idiopathic and neurogenic pelvic floor disorders in patients treated at a referral center. Methods This retrospective observational study analyzed the records of 106 patients tested at our department from December 1999 to January 2017. The efficacy variables evaluated were the Global Response Assessment (range, 0%–100%) and, according to the clinical indication, other specific variables such International Consultation on Incontinence QuestionnaireShort Form, number of catheterizations or pads/day, and the numerical pain scale. The safety variables analyzed were complications (pain, migration, infection), reinterventions and explants. Patients’ quality of life (QoL) and satisfaction with the procedure were evaluated through telephone interviews. Results The clinical indications were overactive bladder (OAB) (n=36), urinary retention (UR) (n=37), bladder pain syndrome/interstitial cystitis (BPS/IC) (n=19), fecal incontinence (FI) (n=8), and double incontinence (DI) (n=6). The implant rates according to the clinical indication were as follows: OAB, 55.6%; UR, 56.8%; BPS/IC, 63.15%; FI, 87.5%; and DI, 66.7%. Clinical and/or statistically significant improvements in all efficacy variables were observed. Loss of therapeutic effect at 75 months of follow-up was observed in 34% of patients. Device-related pain appeared in 25 patients (39%); in 20 patients, it was resolved by reprogramming and 5 patients required device removal. An overall improvement in QoL and high levels of satisfaction with the procedure were observed. More than 90% of patients would recommend SNS to a friend or relative. Conclusions SNS is a minimally invasive procedure that offers a real alternative to patients with refractory pelvic floor dysfunction. Its safety profile is very favorable and it provides a long-lasting improvement in symptoms and QoL.
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Meng L, Tian Z, Zhang W, Zhang Y, Wang J, Liao L, Ling Q, Zhang P, Wei Z, Zhong T, Xu Z, Wen W, Li J, Luo D. Influence of patient sex on the effectiveness of sacral neuromodulation: A cohort study from China. Int J Surg 2020; 84:13-17. [PMID: 33080412 DOI: 10.1016/j.ijsu.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sacral neuromodulation (SNM) has been widely used to treat lower urinary tract dysfunction. Studies have shown a higher conversion rate among female patients than among male patients. However, the influence of gender on the clinical effectiveness of SNM remains unclear. We aimed to confirm whether patients of both genders show similar benefits after SNM treatment. MATERIALS AND METHODS Clinical data of patients with lower urinary tract symptoms associated with pelvic floor dysfunction (overactive bladder, neurogenic bladder, interstitial cystitis/painful bladder syndrome, idiopathic urinary retention) treated with SNM in 10 medical centres in China between January 2012 and December 2016 were retrospectively collected. The patients were classified by gender. Variations in objective (voiding diary) and subjective scores in the baseline, testing, and last follow-up periods were compared. Data were analysed using statistical measures. RESULTS The study included 203 patients (93 males, 110 females). There were no statistical differences in baseline information between the two groups, both groups showed improvement over time. Unsatisfactory improvement was observed in the quality of life and sexual life scores of both groups over the entire treatment period (all p>0.05). Although there was a difference in the maximum voiding volume between the groups at baseline, no difference was observed at the last follow-up (p = 0.004, p = 0.044, p = 0.124), unlike in the average volume where a difference was noted at the last follow-up (p = 0.085, p = 0.964, p = 0.031). While there were no differences in quality of life, sexual life, or pelvic pain and urinary urgency frequency scores at baseline, a significant difference was observed at the last follow-up, and the degree of improvement was less among female patients (p = 0.836, p = 0.131, p = 0.015; p = 0.294, p = 0.265, p = 0.013; p = 0.299, p = 0.087, p = 0.015). CONCLUSION SNM treatment elicited a similar effect on patients of both gender; however, a significant difference was observed regarding patient satisfaction with the treatment. Further preoperative patient education, especially, for female patients with interstitial cystitis/painful bladder syndrome may improve patient satisfaction.
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Affiliation(s)
- Lingfeng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zijian Tian
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, 100068, China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Peng Zhang
- Department of Urology, Beijing Chaoyang Hospital, Institute of Urology, Capital Medical University, Beijing, 100020, China
| | - Zhongqing Wei
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, China
| | - Tie Zhong
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710014, China
| | - Zhihui Xu
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou, 310000, China
| | - Wei Wen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, China
| | - Jiayi Li
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, China
| | - Deyi Luo
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610000, China
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Netto JMB, Scheinost D, Onofrey JA, Franco I. Magnetic resonance image connectivity analysis provides evidence of central nervous system mode of action for parasacral transcutaneous electro neural stimulation - A pilot study. J Pediatr Urol 2020; 16:536-542. [PMID: 32873504 DOI: 10.1016/j.jpurol.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Parasacral transcutaneous electriconeural stimulation (pTENS) is a common treatment modality for patients with overactive bladder (OAB). Its mechanism of effectiveness has yet to be elucidated. Recent studies with fMRI in adults with implanted sacral nerve stimulators impute its effectiveness on changes in the brain involving the anterior cingulate cortex (ACC) and prefrontal cortex (PFC). AIM The study set out to evaluate brain connectivity utilizing functional MRI to the outline the mechanism of action of pTENS in the brain. METHODS Ten adult volunteers without urinary tract symptoms underwent fMRI. Electrodes were placed on the skin at sacral level (S2) (Experimental Stimulation - pTENS) and on the right scapular region (Sham Stimulation - sTENS). Stimulation was done twice on each site for 6 min at a frequency of 10 Hz and pulse width of 260 μs and intensity determined by the motor threshold. A 6 min resting state fMRI was also done twice as control. Functional connectivity data was acquired during each state (resting, pTENS and sTENS). Standard functional connectivity preprocessing was performed. Seed connectivity was examined to investigate changes in ACC functional connectivity between the stimulations and resting-state conditions. Significance was assessed at p < 0.05 corrected for multiple comparisons. RESULTS For all conditions (pTENS, sTENS, and rest), standard patterns of ACC connectivity were detectable with strong connectivity between the ACC and subcortical regions and between the ACC and the frontal lobe. Functional connectivity between ACC seed and the dorsal lateral prefrontal cortex (DLPFC) was significantly increased during pTENS compared to rest. sTENS did not increase connectivity between the ACC seed and DLPFC when compared to rest. DISCUSSION Preliminary results indicate that ACC is a major site of activation during pTENS. Increased connectivity between ACC and DLPFC may be a possible mechanism of pTENS effectiveness, which appears to be specific to pTENS compared to sTENS. This study is limited to the small size at this time which prevents further investigation at other sites in the brain. CONCLUSIONS The study confirms our original aim which was to define if parasacral TENS actually has a central effect.
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Affiliation(s)
- Jose Murillo B Netto
- Yale School of Medicine - Department of Urology, USA; Universidade Federal de Juiz de Fora - Division of Urology, Brazil.
| | - Dustin Scheinost
- Statistics & Data Science - Yale University, USA; Child Study Center - Yale University, USA; Radiology & Biomedical Imaging - Yale University, USA.
| | - John A Onofrey
- Yale School of Medicine - Department of Urology, USA; Radiology & Biomedical Imaging - Yale University, USA.
| | - Israel Franco
- Yale School of Medicine - Department of Urology, USA.
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Kaaki B, Gupta D. Medium-term outcomes of sacral neuromodulation in patients with refractory overactive bladder: A retrospective single-institution study. PLoS One 2020; 15:e0235961. [PMID: 32645082 PMCID: PMC7347151 DOI: 10.1371/journal.pone.0235961] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 06/26/2020] [Indexed: 01/14/2023] Open
Abstract
Background Sacral neuromodulation (SNM) is a minimally invasive fully reversible therapy that was approved in 1997 for overactive bladder syndrome (OAB) refractory to behavior modification and pharmacotherapy. Despite being in use for over two decades, the data on medium to long-term safety and efficacy of SNM in OAB is limited. We investigated the medium-term efficacy and safety of SNM along with the predictive factors for its success in patients with refractory OAB. Methods A retrospective consecutive case series of 66 patients undergoing SNM for refractory OAB between July 2009 and July 2018. All patients underwent a test period followed by permanent implantation, if there was > = 50% improvement in any symptom. The primary outcome was “success” defined as > = 50% improvement in any clinical parameter based on the subjective assessment of patient’s response. The secondary outcomes were number of pads used in 24 hours, post-operative complications and re-operation rates. Results 66 females with an average age of 62.7 years were included. 55/66 patients (83.3%) had a successful test phase and underwent permanent implantation. After a median follow-up of 32 months, SNM was successful in 41/55 (74.5%) patients. Mean number of pads used in 24 hours decreased significantly from 3.5 preoperatively to 1.2 at last follow-up (p<0.001). 8/55 (14.5%) patients reported complications of pain, lead migration, wound dehiscence and device malfunction. 10/55 (18.2%) patients underwent revision surgeries after a median duration of 21.9 months. Device was explanted in 15/55 (27.3%) patients after a median duration of 24 months. No significant predictor for success was identified. Conclusions The success rate of SNM is 75% with a complication rate of 14.5% after a median follow-up of ~3 years. This study suggests medium-term efficacy and safety but a high re-operation rate of SNM in patients with refractory OAB.
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Affiliation(s)
- Bilal Kaaki
- Des Moines University, Des Moines, Iowa, United States of America
- Department of Obstetrics and Gynecology, UnityPoint Health, Waterloo, Iowa, United States of America
- * E-mail:
| | - Digant Gupta
- Clin-Science Research Consulting, Chicago, Illinois, United States of America
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Abstract
Urinary incontinence is a common problem affecting 25-45% women. Effective management can have a huge impact on a patient's quality of life and many treatments are available. Management should be dictated by the degree of bother the symptoms are having, and vary depending on the type on incontinence. Conservative measures should always be initiated, including optimisation of body mass index and smoking cessation. Overactive bladder and urge urinary incontinence can be improved with bladder retraining and avoidance of bladder stimulants. Medical treatment then includes anticholinergic medications or Mirabegron. More invasive options include Botulinum Toxin A (Botox®) injections, sacral nerve stimulation or urological surgery. Stress urinary incontinence should be managed initially with pelvic floor exercises, and input from a specialist nurse or physiotherapist is beneficial. The surgical options for managing stress incontinence have changed considerably over the years, but include bladder neck injections, mid-urethral slings, colposuspension or autologous fascial slings. Mixed urinary incontinence is more challenging to manage, but all conservative measures should be started. Further treatment is directed towards the predominant symptom, but overactivity should be controlled before surgical measures for stress urinary incontinence are performed.
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Sacral Neuromodulation in the Management of Bladder Pain Syndrome/Interstitial Cystitis. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00579-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
PURPOSE OF REVIEW The present review highlights regenerative electrical stimulation (RES) as potential future treatment options for patients with nerve injuries leading to urological dysfunction, such as urinary incontinence, voiding dysfunction or erectile dysfunction. Additionally, it will highlight the mechanism of nerve injury and regeneration as well as similarities and differences between RES and current electrical stimulation treatments in urology, functional electrical stimulation (FES) and neuromodulation. RECENT FINDINGS It has been demonstrated that RES upregulates brain-derived neurotrophic factor (BDNF) and its receptor to facilitate neuroregeneration, facilitating accurate reinnervation of muscles by motoneurons. Further, RES upregulates growth factors in glial cells. Within the past 2 years, RES of the pudendal nerve upregulated BDNF in Onuf's nucleus, the cell bodies of motoneurons that course through the pudendal nerve and accelerated functional recovery in an animal model of stress urinary incontinence. Additionally, electrical stimulation of the vaginal tissue in an animal model of stress urinary incontinence accelerated functional recovery. SUMMARY RES has great potential but future research is needed to expand the potential beneficial effects of RES in the field of urology.
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Dodge NA, Linder BJ. Techniques for optimizing lead placement during sacral neuromodulation. Int Urogynecol J 2019; 31:1049-1051. [PMID: 31875255 DOI: 10.1007/s00192-019-04208-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 12/03/2019] [Indexed: 11/25/2022]
Abstract
We present a video describing technical considerations for optimizing lead placement for sacral neuromodulation. A 56-year-old female presented with urinary urgency incontinence refractory to behavioral modification, physical therapy, and oral pharmacotherapy. An Interstim device had been placed 3 years prior by another provider, but the patient did not find it beneficial and had uncomfortable stimulation despite reprogramming. After counseling, she opted for device revision. The S3 foramen is identified using fluoroscopy in anterior-posterior and lateral views; a needle is advanced through the cephalad and medial aspect of the foramen and tested for bellows and toe responses. After the directional guide is placed, the introducer is advanced until it is midway through the bony table. The lead, with a curved stylet, is advanced for repeat testing prior to deployment. It should have a cephalad-to-caudad appearance and curve laterally. Motor responses are tested and optimally should be < 2 V with all electrodes. The lead is then advanced fully, deployed, and retested. The patient's daytime frequency improved to 6 per day from 11 per day at baseline; her urgency incontinence and the uncomfortable stimulation resolved. Optimization of lead placement for sacral neuromodulation is crucial for improving clinical results.
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Affiliation(s)
- Nicole A Dodge
- From the Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Brian J Linder
- From the Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of OB/Gyn, Mayo Clinic, Rochester, MN, USA.
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Ereifej ES, Shell CE, Schofield JS, Charkhkar H, Cuberovic I, Dorval AD, Graczyk EL, Kozai TDY, Otto KJ, Tyler DJ, Welle CG, Widge AS, Zariffa J, Moritz CT, Bourbeau DJ, Marasco PD. Neural engineering: the process, applications, and its role in the future of medicine. J Neural Eng 2019; 16:063002. [PMID: 31557730 DOI: 10.1088/1741-2552/ab4869] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Recent advances in neural engineering have restored mobility to people with paralysis, relieved symptoms of movement disorders, reduced chronic pain, restored the sense of hearing, and provided sensory perception to individuals with sensory deficits. APPROACH This progress was enabled by the team-based, interdisciplinary approaches used by neural engineers. Neural engineers have advanced clinical frontiers by leveraging tools and discoveries in quantitative and biological sciences and through collaborations between engineering, science, and medicine. The movement toward bioelectronic medicines, where neuromodulation aims to supplement or replace pharmaceuticals to treat chronic medical conditions such as high blood pressure, diabetes and psychiatric disorders is a prime example of a new frontier made possible by neural engineering. Although one of the major goals in neural engineering is to develop technology for clinical applications, this technology may also offer unique opportunities to gain insight into how biological systems operate. MAIN RESULTS Despite significant technological progress, a number of ethical and strategic questions remain unexplored. Addressing these questions will accelerate technology development to address unmet needs. The future of these devices extends far beyond treatment of neurological impairments, including potential human augmentation applications. Our task, as neural engineers, is to push technology forward at the intersection of disciplines, while responsibly considering the readiness to transition this technology outside of the laboratory to consumer products. SIGNIFICANCE This article aims to highlight the current state of the neural engineering field, its links with other engineering and science disciplines, and the challenges and opportunities ahead. The goal of this article is to foster new ideas for innovative applications in neurotechnology.
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Affiliation(s)
- Evon S Ereifej
- Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States of America. Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America. Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America. Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States of America
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Neuromodulation - a therapeutic option for refractory overactive bladder. A recent literature review. Wideochir Inne Tech Maloinwazyjne 2019; 14:476-485. [PMID: 31908692 PMCID: PMC6939208 DOI: 10.5114/wiitm.2019.85352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/09/2019] [Indexed: 11/17/2022] Open
Abstract
Overactive bladder (OAB) affects approximately 17% of the population. The treatment of this clinical condition is challenging, especially when conservative therapy is not effective. There are limited options for the treatment of recurrent OAB. Neuromodulation has taken a significant place in the therapy of recalcitrant lower urinary tract dysfunctions over the past 20 years. The aim of this study was to review the literature evaluating the different forms of neuromodulation in various urological clinical conditions and to show the future prospects of this treatment method. Further studies are necessary to determine the effectiveness of neuromodulation and to identify the prognostic factors of therapeutic success. This could be helpful in the selection of patients who will be most likely to respond positively to the treatment.
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Patel DN, Zhao HH, Houman J, Ackerman AL, Eilber KS, Anger JT. Comparative effectiveness of one versus two‐stage sacral neurostimulation device placement. Neurourol Urodyn 2019; 38:734-739. [DOI: 10.1002/nau.23908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/30/2018] [Accepted: 11/24/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Devin N. Patel
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - Hanson H. Zhao
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - Justin Houman
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - A. Lenore Ackerman
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - Karyn S. Eilber
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - Jennifer T. Anger
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
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