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Meng L, Yan Z, Wang X, Zhang Y, Zhu Z, Zhu W, Ling Q, Sun X, Gu Y, Lv J, Li Y. Preliminary analysis of stimulation parameters for sacral neuromodulation in different indications: a multicenter retrospective cohort study from China. Int J Surg 2024; 110:3536-3542. [PMID: 38445489 PMCID: PMC11175814 DOI: 10.1097/js9.0000000000001302] [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: 12/20/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Sacral neuromodulation (SNM) is an effective approach for treating lower urinary tract dysfunction (LUTD), and stimulation programming is essential for successful treatment. However, research on SNM programming for various indications is limited. Thus, the authors aimed to determine whether there were differences in the stimulation parameters for different SNM indications and the appropriate programming recommendations. MATERIALS AND METHODS Clinical data were retrospectively collected from patients with LUTD who underwent SNM and completed internal pulse generator implantation. The parameters with the highest patient satisfaction or the most symptom improvement during the test period were considered optimal and used to set the programming after internal pulse generator implantation. RESULTS After screening, 282 patients were enrolled and categorized into four groups based on the following indications: refractory overactive bladder (OAB) ( n =61), neurogenic lower urinary tract dysfunction (nLUTD) ( n =162), interstitial cystitis/painful bladder syndrome (IC/BPS) ( n =24), and idiopathic nonobstructive urinary retention (NOUR) ( n =35). When analyzing the optimal stimulus parameters, disparities in the stimulation amplitude and pulse frequency were noted among the four groups. The stimulation amplitude in the nLUTD group was higher than that in the idiopathic NOUR group ( P =0.013). Differences in pulse frequency were observed between the refractory OAB and nLUTD groups ( P <0.001) and between the refractory OAB and idiopathic NOUR groups ( P =0.001). No differences in the electrode configuration or pulse width settings existed among the four groups. CONCLUSIONS The stimulation parameters for SNM varied among the different indications. For the initial programming of stage I, most patients are recommended to start with stimulation amplitudes below 2 V, although patients with nLUTD may benefit from higher amplitudes. A standard pulse width of 210 μs is recommended for all patients. However, for individuals experiencing nLUTD or idiopathic NOUR, the pulse frequency can begin above the standard 14 Hz but not exceed 50 Hz.
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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 and Peking Union Medical College
| | - Zehao Yan
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xinhao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhikai Zhu
- Center for Big Data, National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Wen Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Qing Ling
- Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan
| | - Xiaoke Sun
- Department of Urology, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | - Yinjun Gu
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine
| | - Jianwei Lv
- Department of Urology, Gongli Hospital of Shanghai Pudong New Area, Shanghai
| | - Yan Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
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Ducrot Q, Brierre T, Roulette P, Soulié M, Castel-Lacanal E, Gamé X. [Sacral neuromodulation for bladder voiding dysfunction: Experience at a French university center]. Prog Urol 2023; 33:1062-1072. [PMID: 37739836 DOI: 10.1016/j.purol.2023.09.001] [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: 06/11/2023] [Revised: 08/21/2023] [Accepted: 09/03/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To report the experience of a university hospital center with sacral neuromodulation for patients with bladder voiding disorders. MATERIAL AND METHODS All patients who underwent sacral neuromodulation between 1998 and 2022 for bladder voiding disorders were included. Medical records were analyzed retrospectively, and population, efficacy and follow-up data were collected. RESULTS A total of 134 patients underwent test implantation and 122 patients were analyzed. 68 patients (56%) were implanted with a definitive neuromodulation device. Mean age was 43±16 years and BMI 25.5±5.4kg/m2. 74% were women. Bladder voiding disorder was due to sphincter hypertonia in 51% of cases, with associated bladder hypocontractility in 29%. The spontaneous micturition rate after implantation increased from 34% to 92%. Implantation results appeared to be better in patients with sphincter hypertonia, whether or not associated with bladder hypocontractility. The benefit was most often present with a frequency of 5Hz (54.4%). Side-effects were present in 52% of cases at 5 years, and in 85% of cases were pain in relation to the implanted devices. They resolved under medical treatment or after revision of the device (27% of cases at 5 years). CONCLUSION SNM is effective in micturition recovery, but has side effects. Urodynamic mechanism and etiology may provide clues for modulating NMS box settings and determining predictive factors for NMS success. Data from other centers are needed to identify reliable predictive factors.
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Affiliation(s)
- Q Ducrot
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse cedex, France.
| | - T Brierre
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse cedex, France
| | - P Roulette
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse cedex, France
| | - M Soulié
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse cedex, France
| | - E Castel-Lacanal
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse cedex, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse cedex, France
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Dudding TC, Lehur PA, Sørensen M, Engelberg S, Bertapelle MP, Chartier-Kastler E, Everaert K, Van Kerrebroeck P, Knowles CH, Lundby L, Matzel KE, Muñoz-Duyos A, Rydningen MB, de Wachter S. Reprogramming Sacral Neuromodulation for Sub-Optimal Outcomes: Evidence and Recommendations for Clinical Practice. Neuromodulation 2021; 24:1247-1257. [PMID: 34264542 PMCID: PMC9291141 DOI: 10.1111/ner.13494] [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: 03/01/2021] [Revised: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022]
Abstract
Objectives In some patients treated for urinary or fecal incontinence with sacral neuromodulation (SNM) persistence of symptoms, a reduction in efficacy or adverse effects of stimulation can occur. In such situations, further programming of the SNM device can help resolve problems. Infrequently hardware failure is detected. This article aims to provide practical guidance to solve sub‐optimal outcomes (troubleshooting) occurring in the course of SNM therapy. Materials and Methods A systematic literature review was performed. Collective clinical experience from an expert multidisciplinary group was used to form opinion where evidence was lacking. Results Circumstances in which reprogramming is required are described. Actions to undertake include changes of electrode configuration, stimulation amplitude, pulse frequency, and pulse width. Guidance in case of loss of efficacy and adverse effects of stimulation, developed by a group of European experts, is presented. In addition, various hardware failure scenarios and their management are described. Conclusions Reprogramming aims to further improve patient symptoms or ensure a comfortable delivery of the therapy. Initial changes of electrode configuration and adjustment of stimulation parameters can be performed at home to avoid unnecessary hospital visits. A logical and stepwise approach to reprogramming can improve the outcome of therapy and restore patient satisfaction.
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Affiliation(s)
- Thomas C Dudding
- Pelvic Floor Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul A Lehur
- Coloproctology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Michael Sørensen
- Department of Surgical and Medical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark
| | | | - Maria Paola Bertapelle
- Neurourology Maria Adelaide Hospital, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | | | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Philip Van Kerrebroeck
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Charles H Knowles
- Centre for Neuroscience, Surgery & Trauma, Blizard Institute, Queen Mary University of London & Barts Health NHS Trust, London, UK
| | - Lilli Lundby
- Pelvic Floor Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Klaus E Matzel
- Chirurgische Klinik, Sektion Koloproktologie, Universität Erlangen, Erlangen, Germany
| | - Arantxa Muñoz-Duyos
- Coloproctology Unit, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Mona B Rydningen
- Norwegian National Advisory Unit on Incontinence and Pelvic Floor Health, University Hospital of North Norway, Tromso, Norway
| | - Stefan de Wachter
- Department of Urology, Faculty of Health Sciences, University Hospital Antwerpen, University Antwerpen, Edegem, Belgium
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Assmann R, Douven P, Kleijnen J, van Koeveringe GA, Joosten EA, Melenhorst J, Breukink SO. Stimulation Parameters for Sacral Neuromodulation on Lower Urinary Tract and Bowel Dysfunction-Related Clinical Outcome: A Systematic Review. Neuromodulation 2020; 23:1082-1093. [PMID: 32830414 PMCID: PMC7818464 DOI: 10.1111/ner.13255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 01/03/2023]
Abstract
Objective Sacral neuromodulation (SNM) has been used to treat patients with lower urinary tract dysfunction and bowel dysfunction for many years. Success rates vary between 50% and 80%, indicating that there is much room for improvement. Altering stimulation parameters may result in improved outcome. This paper reports a systematic review of the clinical efficacy of nonconventional stimulation parameters on urinary tract and bowel dysfunction. Materials and Methods Three databases were used for the literature search: Ovid (Medline, Embase) and PubMed. Papers were screened by two independent reviewers, who also extracted data from these papers. Clinical papers studying SNM stimulation parameters, that is, intermittent stimulation, frequency, pulse width, and amplitude, in urinary tract and bowel dysfunction were included. Quality of included papers was assessed using standardized guidelines. Results Out of 5659 screened papers, 17 papers, studying various stimulation parameters, were included. Overall quality of these papers differed greatly, as some showed no risk of bias, whereas others showed high risk of bias. Stimulation parameters included intermittent stimulation, frequency, pulse width, amplitude, and unilateral vs. bilateral stimulation. Especially high frequency SNM and either a narrow or wide pulse width seem to improve efficacy in patients with bowel dysfunction. Additionally, implementation of short cycling intervals is promising to improve quality of life for patients with urinary tract or bowel dysfunction. Conclusion The results of our systematic review indicate that stimulation parameters may improve efficacy of SNM in treatment of both urinary tract dysfunction and bowel dysfunction.
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Affiliation(s)
- Roman Assmann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), University of Maastricht, Maastricht, The Netherlands
| | - Perla Douven
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), University of Maastricht, Maastricht, The Netherlands.,Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Anesthesiology and Pain Management, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Gommert A van Koeveringe
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), University of Maastricht, Maastricht, The Netherlands.,Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elbert A Joosten
- Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), University of Maastricht, Maastricht, The Netherlands.,Department of Anesthesiology and Pain Management, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephanie O Breukink
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), University of Maastricht, Maastricht, The Netherlands
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Malde S, Marcelissen T, Vrijens D, Apostilidis A, Rahnama'I S, Cardozo L, Lovick T. Sacral nerve stimulation for refractory OAB and idiopathic urinary retention: Can phenotyping improve the outcome for patients: ICI-RS 2019? Neurourol Urodyn 2020; 39 Suppl 3:S96-S103. [PMID: 32662561 DOI: 10.1002/nau.24204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 11/09/2022]
Abstract
AIMS Sacral nerve stimulation (SNS) is widely used to treat refractory idiopathic overactive bladder (OAB) and idiopathic urinary retention. However, clinical outcomes are variable and understanding predictive factors for success or side-effects would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence-Research Society meeting 2019, a Think Tank was convened to discuss how advances in the basic science study of SNS may be translatable into clinical practice to improve outcomes of patients undergoing SNS treatment. METHODS We conducted a literature review and expert consensus meeting focusing on current methods of phenotyping patients and specifically, how advances in basic science research of the mechanism of action of SNS can be translated into clinical practice to improve patient selection for therapy. RESULTS The terms "Idiopathic OAB" and "idiopathic urinary retention" encompass several underlying pathophysiological phenotypes. Commonly, phenotyping is based on clinical and urodynamic factors. Animal studies have demonstrated that high-frequency stimulation can produce rapid onset, reversible conduction block in peripheral nerves. Altering stimulation parameters may potentially enable personalization of therapy depending upon the clinical indication in the future. Similarly, advances in conditional and closed-loop stimulation may offer greater efficacy for certain patients. Phenotyping based on psychological comorbidity requires further study to potentially optimize patient selection for therapy. CONCLUSIONS Idiopathic OAB and idiopathic urinary retention are heterogenous conditions with multiple potential underlying phenotypes. Tailoring stimulation parameters to the needs of each individual according to phenotype could optimize outcomes. Assessing psychological comorbidity may improve patient selection. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sajjad Rahnama'I
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Thelma Lovick
- School of Physiology, Pharmacology, and Neuroscience, University of Bristol, Bristol, UK
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Lehur PA, Sørensen M, Dudding TC, Knowles CH, de Wachter S, Engelberg S, Matzel KE. Programming Algorithms for Sacral Neuromodulation: Clinical Practice and Evidence-Recommendations for Day-to-Day Practice. Neuromodulation 2020; 23:1121-1129. [PMID: 32153080 PMCID: PMC7818413 DOI: 10.1111/ner.13117] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/03/2019] [Accepted: 01/14/2020] [Indexed: 01/21/2023]
Abstract
Background In sacral neuromodulation (SNM), stimulation programming plays a key role to achieve success of the therapy. However to date, little attention has been given to the best ways to set and optimize SNM programming during the test and chronic stimulation phases of the procedure. Objective Standardize and make SNM programming easier and more efficient for the several conditions for which SNM is proposed. Methods Systematic literature review and collective clinical experience report. Results The basic principles of SNM programming are described. It covers choice of electrode configuration, stimulation amplitude, pulse frequency and pulse widths, while use of cycling is also briefly discussed. Step‐by‐step practical flow charts developed by a group of 13 European experts are presented. Conclusions Programming of SNM therapy is not complex. There are few programming settings that seem beneficial or significantly impact patient outcomes. Only four basic electrode configurations could be identified according to four different options to define the cathode. In a majority of patients, the proposed stimulation parameters will allow a satisfactory improvement for long periods of time. A regular follow‐up is, however, necessary to assess and eventually optimize results, as well as to reassure patients.
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Affiliation(s)
- Paul A Lehur
- Coloproctology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Michael Sørensen
- Department of Surgical and Medical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Thomas C Dudding
- Department of Gastrointestinal Surgery, University Hospital Southampton, Southampton, UK
| | - Charles H Knowles
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Queen Mary University of London, Barts Health NHS Trust, London, UK
| | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, Antwerpen, Belgium.,Faculty of Health Sciences, University of Antwerpen, Antwerpen, Belgium
| | | | - Klaus E Matzel
- Chirurgische Klinik, Universität Erlangen, Erlangen, Germany
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Chermansky C, Schurch B, Rahnama'i MS, Averbeck MA, Malde S, Mancini V, Valentini F, Sahai A. How can we better manage drug‐resistant OAB/DO? ICI‐RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S46-S55. [DOI: 10.1002/nau.24055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/31/2019] [Accepted: 05/19/2019] [Indexed: 01/20/2023]
Affiliation(s)
| | - Brigitte Schurch
- Department of Clinical Neurosciences, Neuropsychology and Neurorehabilitation ServiceVaudois University Hospital of LausanneLausanne Switzerland
| | - Mohammad S. Rahnama'i
- Department of UrologyUniversity Hospital RWTH AachenAachen Germany
- Maastricht UniversityMaastricht The Netherlands
| | | | - Sachin Malde
- Department of UrologyGuy's Hospital & King's College School of MedicineLondon United Kingdom
| | - Vito Mancini
- Urology and Renal Transplant Unit, Ospedali RiunitiUniversity of FoggiaFoggia Italy
| | - Francoise Valentini
- Department of Physical Medicine and RehabilitationHôpital RothschildParis France
| | - Arun Sahai
- Department of UrologyGuy's Hospital & King's College School of MedicineLondon United Kingdom
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Bandari J, Bansal U, Zhang Z, Shen B, Wang J, Lamm V, Chang V, Roppolo JR, de Groat WC, Tai C. Neurotransmitter Mechanisms Underlying Sacral Neuromodulation of Bladder Overactivity in Cats. Neuromodulation 2016; 20:81-87. [PMID: 27730701 DOI: 10.1111/ner.12534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/02/2016] [Accepted: 09/10/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the role of opioid, β-adrenergic, and metabotropic glutamate 5 receptors in sacral neuromodulation of bladder overactivity. MATERIAL AND METHODS In α-chloralose anesthetized cats, intravesical infusion of 0.5% acetic acid (AA) irritated the bladder and induced bladder overactivity. Electric stimulation (5 Hz, 0.2 ms, 0.16-0.7V) of S1 or S2 sacral dorsal roots inhibited the bladder overactivity. Naloxone, propranolol, or MTEP were given intravenously (i.v.) to determine different neurotransmitter mechanisms. RESULTS AA significantly (p < 0.05) reduced bladder capacity to 7.7 ± 3.3 mL from 12.0 ± 5.0 mL measured during saline infusion. S1 or S2 stimulation at motor threshold intensity significantly (p < 0.05) increased bladder capacity to 179.4 ± 20.0% or 219.1 ± 23.0% of AA control, respectively. Naloxone (1 mg/kg) significantly (p < 0.001) reduced the control capacity to 38.3 ± 7.3% and the bladder capacity measured during S1 stimulation to 106.2 ± 20.8% of AA control, but did not significantly change the bladder capacity measured during S2 stimulation. Propranolol (3 mg/kg) significantly (p < 0.01) reduced bladder capacity from 251.8 ± 32.2% to 210.9 ± 33.3% during S2 stimulation, but had no effect during S1 stimulation. A similar propranolol effect also was observed in naloxone-pretreated cats. In propranolol-pretreated cats during S1 or S2 stimulation, MTEP (3 mg/kg) significantly (p < 0.05) reduced bladder capacity and naloxone (1 mg/kg) following MTEP treatment further reduced bladder capacity. However, a significant inhibition could still be induced by S1 or S2 stimulation after all three drugs were administered. CONCLUSIONS Neurotransmitter mechanisms in addition to those activating opioid, β-adrenergic, and metabotropic glutamate 5 receptors also are involved in sacral neuromodulation.
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Affiliation(s)
- Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Utsav Bansal
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zhaocun Zhang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Urology, Qilu Hospital, Shandong University, Jinan, China
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vladimir Lamm
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor Chang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA, USA
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Zhang Z, Bandari J, Bansal U, Shen B, Wang J, Lamm V, Roppolo JR, de Groat WC, Tai C. Sacral neuromodulation of nociceptive bladder overactivity in cats. Neurourol Urodyn 2016; 36:1270-1277. [PMID: 27571328 DOI: 10.1002/nau.23105] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/05/2016] [Indexed: 01/23/2023]
Abstract
AIMS To investigate the effects of electrical stimulation of sacral dorsal/ventral roots on irritation-induced bladder overactivity, reveal possible different mechanisms under nociceptive bladder conditions, and establish a large animal model of sacral neuromodulation. METHODS Intravesical infusion of 0.5% acetic acid (AA) was used to irritate the bladder and induce bladder overactivity in cats under α-chloralose anesthesia. Electrical stimulation (5, 15, or 30 Hz) was applied to individual S1-S3 dorsal or ventral roots at or below motor threshold intensity. Repeated cystometrograms (CMGs) were performed with/without the stimulation to determine the inhibition of bladder overactivity. RESULTS AA irritation induced bladder overactivity and significantly (P < 0.05) reduced the bladder capacity to 62.6 ± 11.7% of control capacity measured during saline CMGs. At threshold intensity for inducing reflex twitching of the anal sphincter or toe, S1/S2 dorsal root stimulation at 5 Hz but not at 15 or 30 Hz inhibited bladder overactivity and significantly (P < 0.05) increased bladder capacity to 187.3 ± 41.6% and 155.5 ± 9.7% respectively, of AA control capacity. Stimulation of S3 dorsal root or S1-S3 ventral roots was not effective. Repeated stimulation of S1-S3 dorsal root did not induced a post-stimulation inhibition. CONCLUSIONS This study established a cat model of sacral neuromodualation of nociceptive bladder overactivity. The results revealed that the mechanisms underlying sacral neuromodulation are different for nociceptive and non-nociceptive bladder activity.
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Affiliation(s)
- Zhaocun Zhang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Utsav Bansal
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vladimir Lamm
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Prospective Randomized Crossover Trial Comparing Continuous and Cyclic Stimulation in InterStim Therapy. Female Pelvic Med Reconstr Surg 2016; 21:355-8. [PMID: 26506165 DOI: 10.1097/spv.0000000000000188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to assess a difference in efficacy and patient preference in cyclic versus continuous stimulation with InterStim therapy for urge incontinence or urinary frequency. METHODS Patients with refractory urge incontinence/urinary frequency and with recent implantation of the InterStim system were randomized to continuous or cyclic InterStim stimulation after institutional review board-approved consent. They completed a 3-day voiding diary after 1 month of stimulation. They were then switched to the alternative setting for 1 month and completed another voiding diary. Subjective responses were evaluated with the Urinary Incontinence Impact Questionnaire and the Urinary Distress Inventory. Patient preference of stimulation setting was assessed. Statistical analysis was performed with paired t tests and repeated-measures analysis of variance. RESULTS Data were available for 32 patients. Indication for InterStim: urge incontinence = 24, frequency = 8. No differences were noted in the number of urgency or urge incontinence episodes (mild, moderate, severe, or total) with cyclic or continuous stimulation. No differences were noted in the number of number of pads per day or the number of daytime or nighttime voids. The Urinary Incontinence Impact Questionnaire and Urinary Distress Inventory symptoms scores showed no significant differences between cyclic and continuous stimulation. No significant difference was noted in measured parameters based on the order of stimulation. Continuous stimulation was preferred by 17 patients, 9 preferred cyclic stimulation, and 6 had no preference. CONCLUSIONS No significant differences were noted in voiding diaries and subjective responses between cyclic and continuous stimulation in InterStim therapy for patients with urge incontinence or frequency.
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Tse V, King J, Dowling C, English S, Gray K, Millard R, O'Connell H, Pillay S, Thavaseelan J. Conjoint Urological Society of Australia and New Zealand (USANZ) and Urogynaecological Society of Australasia (UGSA) Guidelines on the management of adult non-neurogenic overactive bladder. BJU Int 2015; 117:34-47. [PMID: 26456313 DOI: 10.1111/bju.13246] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Due to the myriad of treatment options available and the potential increase in the number of patients afflicted with overactive bladder (OAB) who will require treatment, the Female Urology Special Advisory Group (FUSAG) of the Urological Society of Australia and New Zealand (USANZ), in conjunction with the Urogynaecological Society of Australasia (UGSA), see the need to move forward and set up management guidelines for physicians who may encounter or have a special interest in the treatment of this condition. These guidelines, by utilising and recommending evidence-based data, will hopefully assist in the diagnosis, clinical assessment, and optimisation of treatment efficacy. They are divided into three sections: Diagnosis and Clinical Assessment, Conservative Management, and Surgical Management. These guidelines will also bring Australia and New Zealand in line with other regions of the world where guidelines have been established, such as the American Urological Association, European Association of Urology, International Consultation on Incontinence, and the National Institute for Health and Care Excellence guidelines of the UK.
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Affiliation(s)
- Vincent Tse
- Concord Hospital, University of Sydney, Sydney, NSW, Australia
| | - Jennifer King
- Pelvic Floor Unit, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Caroline Dowling
- Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic., Australia
| | | | | | - Richard Millard
- Prince of Wales Hospital, University of New South Wales, NSW, Australia
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Gilleran JP, Killinger K, Boura J, Peters KM. Number of active electrodes at time of staged tined lead interstim implant does not impact clinical outcomes. Neurourol Urodyn 2015; 35:625-9. [DOI: 10.1002/nau.22766] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/23/2015] [Indexed: 11/09/2022]
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Peeters K, Sahai A, De Ridder D, Van Der Aa F. Long-term follow-up of sacral neuromodulation for lower urinary tract dysfunction. BJU Int 2014; 113:789-94. [PMID: 24238278 DOI: 10.1111/bju.12571] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To report our long-term experience of sacral neuromodulation (SNM) for various lower urinary tract dysfunctions but with a focus on efficacy, safety, re-interventions and degree of success. PATIENTS AND METHODS This is a single tertiary referral centre study that included 217 patients (86% female) who received an implantable pulse generator (IPG) (Interstim™, Medtronic, Minneapolis, USA) between 1996 and 2010. Success was considered if the initial ≥50% improvement in any of primary voiding diary variables persisted compared with baseline, but was further stratified. RESULTS The mean duration of follow-up was 46.88 months. Success and cure rates were ≈70% and 20% for urgency incontinence, 68% and 33% for urgency frequency syndrome and 73% and 58% for idiopathic retention. In those patients with an unsuccessful therapy outcome, the mean time to failure was 24.6 months after implantation. There were 88 (41%) patients who had at least one device or treatment related surgical re-intervention. The re-intervention rate was 1.7 per patient with most of them (47%) occurring ≤2 years of follow-up. CONCLUSIONS SNM appears effective in the long-term with a success rate after definitive IPG implant of ≈70% and complete cure rates ranging between 20% and 58% depending on indication. Patients with idiopathic retention appear to do best. The re-intervention rate is high with most occurring ≤2 years of implantation. It is likely that with the newer techniques used, efficacy and re-intervention rates will improve.
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Affiliation(s)
- Karlien Peeters
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Zhang F, Zhao S, Shen B, Wang J, Nelson DE, Roppolo JR, de Groat WC, Tai C. Neural pathways involved in sacral neuromodulation of reflex bladder activity in cats. Am J Physiol Renal Physiol 2013; 304:F710-7. [PMID: 23283999 DOI: 10.1152/ajprenal.00334.2012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined the mechanisms underlying the effects of sacral neuromodulation on reflex bladder activity in chloralose-anesthetized cats. Bladder activity was recorded during cystometrograms (CMGs) or under isovolumetric conditions. An S1-S3 dorsal (DRT) or ventral root (VRT) was electrically stimulated at a range of frequencies (1-30 Hz) and at intensities relative to threshold (0.25-2T) for evoking anal/toe twitches. Stimulation of DRTs but not VRTs at 1T intensity and frequencies of 1-30 Hz inhibited isovolumetric rhythmic bladder contractions. A 5-Hz DRT stimulation during CMGs was optimal for increasing (P < 0.05) bladder capacity (BC), but stimulation at 15 and 30 Hz was ineffective. Stimulation of the S1 DRT was more effective (increases BC to 144% and 164% of control at 1T and 2T, respectively) than S2 DRT stimulation (increases BC to 132% and 150% of control). Bilateral transection of the hypogastric or pudendal nerves did not change the inhibitory effect induced by S1 DRT stimulation. Repeated stimulation of S1 and S2 DRTs during multiple CMGs elicited a significant (P < 0.05) increase in BC (to 155 ± 11% of control) that persisted after termination of the stimulation. These results in cats suggest that the inhibition of reflex bladder activity by sacral neuromodulation occurs primarily in the central nervous system by inhibiting the ascending or descending pathways of the spinobulbospinal micturition reflex.
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Affiliation(s)
- Fan Zhang
- Department of Urology, University of Pittsburgh, Pittsburgh, PA 15213, USA
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PETERS KM, SHEN L, MCGUIRE M. Effect of Sacral Neuromodulation Rate on Overactive Bladder Symptoms: A Randomized Crossover Feasibility Study. Low Urin Tract Symptoms 2012; 5:129-33. [DOI: 10.1111/luts.12000] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Duelund-Jakobsen J, Dudding T, Bradshaw E, Buntzen S, Lundby L, Laurberg S, Vaizey C. Randomized double-blind crossover study of alternative stimulator settings in sacral nerve stimulation for faecal incontinence. Br J Surg 2012; 99:1445-52. [DOI: 10.1002/bjs.8867] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Sacral nerve stimulation is an established treatment for faecal incontinence. Nearly half of all patients experience loss of efficacy at some point. Standard reprogramming restores efficacy for some, but not all, patients. This study aimed to determine whether alternative stimulator settings would increase treatment efficacy.
Methods
Patients with sustained loss of efficacy were recruited from two international specialist centres. A number of alternative stimulation parameters were tested using a double-blind randomized crossover study design. Stimulation settings tested were pulse frequencies of 6·9 and 31 Hz, and pulse widths of 90 and 330 µs, compared with one standard setting of 14 Hz/210 µs. Treatment efficacy was evaluated using a disease-specific quality-of-life score (Fecal Incontinence Quality of Life Scale, FIQLS) and a bowel habit diary completed before randomization, during the study period and after 3 months of follow-up with one preferred setting.
Results
Fifteen patients were analysed. With one preferred setting, three of four subdomains in the FIQLS improved significantly. The mean(s.d.) total number of incontinence episodes dropped from 11·7(10·8) to 4·8(4·5) per 3 weeks (P = 0·011) and improvements were maintained after 3 months of follow-up. Optimal pacemaker settings were individual, but a trend towards highest patient satisfaction and improved treatment outcome was evident for high-frequency stimulation (31 Hz/210 µs), which was preferred by eight of the 15 patients.
Conclusion
Patients experiencing loss of efficacy can experience improvement if alternative pacemaker settings are tested. High-frequency stimulation (31 Hz/210 µs) was preferred by more than half of the patients, and improved treatment outcome was sustained at 3 months. Registration number: NCT01254695 (http://www.clinicaltrials.gov).
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Affiliation(s)
- J Duelund-Jakobsen
- Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
- Physiology Unit, St Mark's Hospital, Harrow, UK
| | - T Dudding
- Physiology Unit, St Mark's Hospital, Harrow, UK
| | - E Bradshaw
- Physiology Unit, St Mark's Hospital, Harrow, UK
| | - S Buntzen
- Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - L Lundby
- Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - S Laurberg
- Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
| | - C Vaizey
- Physiology Unit, St Mark's Hospital, Harrow, UK
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