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Seitz V, Calata J, Mei L, Davidson ERW. Racial Disparities in Sacral Neuromodulation for Idiopathic Fecal Incontinence. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00221. [PMID: 38710021 DOI: 10.1097/spv.0000000000001520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
IMPORTANCE Sacral neuromodulation (SNM) is an effective treatment for fecal incontinence (FI). Previous studies found that Black women undergo SNM for urinary incontinence less than White women, but there is less known about racial disparities for FI. OBJECTIVE This study assessed differences in Black and White patients' FI treatment; SNM counseling was the primary outcome. STUDY DESIGN This was a retrospective cohort study of adult non-Hispanic Black and White patients who received FI treatment at an academic institution from 2011 to 2021. Medical records were queried for treatments, testing, and treating specialties for a 2:1 age-matched cohort of White:Black patients. RESULTS Four hundred forty-seven women were included: 149 Black women and 298 age-matched White women. A total of 24.4% (109) of patients had documented SNM counseling, significantly fewer in Black patients (14.8% vs 29.2%, P < 0.001). A total of 5.1% (23) of patients received SNM, less frequent in Black patients (2.7% vs 6.4%, P = 0.003). Among patients with SNM counseling, there was no difference between cohorts. Black patients were less likely to be referred for physical therapy (59.7% vs 77.2%, P < 0.001), sphincter imaging (0.7% vs 5.7%, P = 0.011), and defecography (8.1% vs 17.1%, P = 0.009). Different specialties managed the 2 cohorts. Black patients were less likely to see urogynecology and colorectal surgery (21.5% vs 34.6%, P = 0.004; 9.4% vs 15.4%, P = 0.077). Patients seen by these surgeons were more likely to discuss SNM (48.6% vs 8.5%, P < 0.001). CONCLUSIONS There were differences between Black and White patients' FI treatment, including counseling about SNM. Multidisciplinary work is needed to provide equitable education for this life-altering condition.
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Kaufmann A, Leitner L. [Neurogenic, non-obstructive urinary retention: diagnosis and treatment]. Aktuelle Urol 2024. [PMID: 38657657 DOI: 10.1055/a-2266-4721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Neurogenic, non-obstructive urinary retention has a varied aetiology. The condition can be caused by central-nervous diseases as well as by disorders of the peripheral nervous system. The formation of residual urine may lead to considerable problems that can have a significant impact on a patient's everyday life. A treatment appropriate for the lower urinary tract dysfunction and suited to the patient's situation in life is only possible if a differentiated diagnostic evaluation has been performed. Both conservative and surgical therapeutic strategies are available, while drug treatment approaches are less relevant. Neuromodulative procedures are particularly suitable for causal treatment of the dysfunction. For patients requiring artificial bladder voiding, intermittent self-catheterization is generally preferable to using an indwelling catheter.
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Affiliation(s)
- Albert Kaufmann
- Neuro-Urologie, Schweizer Paraplegiker Zentrum, Nottwil, Schweiz
| | - Lorenz Leitner
- Neuro-Urologie, Universitätsklinik Balgrist, Universität Zürich, Zürich, Schweiz
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Mancini V, Damaser MS, Chermansky C, Ochoa CD, Hashim H, Przydacz M, Hervé F, Martino L, Abrams P. Can we improve techniques and patients' selection for nerve stimulation suitable for lower urinary tract dysfunctions? ICI-RS 2023. Neurourol Urodyn 2023. [PMID: 38048061 DOI: 10.1002/nau.25346] [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: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/05/2023]
Abstract
AIMS Lower urinary tract dysfunctions (LUTD) are very common and, importantly, affect patients' quality of life (QoL). LUTD can range from urinary retention to urgency incontinence and includes a variety of symptoms. Nerve stimulation (NS) is an accepted widespread treatment with documented success for LUTD and is used widely. The aim of this review is to report the results of the discussion about how to improve the outcomes of NS for LUTD treatment. METHODS During its 2023 meeting in Bristol, the International Consultation on Incontinence Research Society discussed a literature review, and there was an expert consensus discussion focused on the emerging awareness of NS suitable for LUTD. RESULTS The consensus discussed how to improve techniques and patients' selection in NS, and high-priority research questions were identified. CONCLUSIONS Technique improvement, device programming, and patient selection are the goals of the current approach to NS. The conditional nerve stimulation with minimally invasive wireless systems and tailored algorithms hold promise for improving NS for LUTD, particularly for patients with neurogenic bladder who represent the new extended population to be treated.
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Affiliation(s)
- Vito Mancini
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, and Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | | | - Carolina D Ochoa
- Bristol Urological Institute, North Bristol Trust, University of Bristol, Bristol, UK
| | - Hashim Hashim
- Bristol Urological Institute, North Bristol Trust, University of Bristol, Bristol, UK
| | - Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Leonardo Martino
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Paul Abrams
- Bristol Urological Institute, University of Bristol, Bristol, UK
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Babin CP, Catalano NT, Yancey DM, Pearl NZ, Koonce EM, Ahmadzadeh S, Shekoohi S, Cornett EM, Kaye AD. Update on Overactive Bladder Therapeutic Options. Am J Ther 2023:00045391-990000000-00151. [PMID: 37171410 DOI: 10.1097/mjt.0000000000001637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Millions of Americans are burdened by overactive bladder (OAB) syndrome and the psychogenic and economic hardships that accompany it. Several theories attempt to explain OAB as a neurogenic dysfunction, myogenic dysfunction, urothelial dysfunction, or decreased expression of a channel protein secondary to bladder outlet obstruction. Given that the etiology of OAB is a working theory, the management of OAB is also an evolving subject matter in medicine. There are uncertainties surrounding the pathophysiology of OAB, the strength of a clinical diagnosis, and accurate reporting because of the disease's stigma and decreased use of health care. DATA SOURCES This is a narrative review that used PubMed, Google Scholar, Medline, and ScienceDirect to review literature on current and future OAB therapies. RESULTS Currently, first-line treatment for OAB is behavioral therapy that uses lifestyle modifications, bladder-control techniques, and psychotherapy. Second-line therapy includes antimuscarinic agents or beta 3 adrenergic agonists, and studies have shown that combination therapy with antimuscarinics and beta 3 adrenergic agonists provides even greater efficacy than monotherapy. Third-line therapies discussed include onabotulinumtoxinA, posterior tibial nerve stimulation, and sacral neuromodulation. OnabotulinumtoxinA has been FDA-approved as a nonpharmaceutical treatment option for refractory OAB with minimal side effects restricted to the urinary tract. Posterior tibial nerve modulation and sacral neuromodulation are successful in treating refractory OAB, but the costs and complication rates make them high-risk procedures. Therefore, surgical intervention should be a last resort. Estrogen therapy is effective in alleviating urinary incontinence in postmenopausal women, consistent with the association between estrogen deficiency and genitourinary syndrome. Potassium channel activators, voltage-gated calcium channel blockers, and phosphodiesterase inhibitors look to be promising options for the future of OAB management. As new therapies are developed, individuals with OAB can better personalize their treatment to maximize their quality of life and cost-effective care.
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Affiliation(s)
- Caroline P Babin
- Louisiana State University Health Sciences Center at New Orleans, School of Medicine, New Orleans, LA
| | - Nicole T Catalano
- Louisiana State University Health Sciences Center at New Orleans, School of Medicine, New Orleans, LA
| | - David M Yancey
- Louisiana State University Health Sciences Center at New Orleans, School of Medicine, New Orleans, LA
| | - Nathan Z Pearl
- Louisiana State University Health Sciences Center at New Orleans, School of Medicine, New Orleans, LA
| | - Eleanor M Koonce
- Louisiana State University Health Sciences Center at New Orleans, School of Medicine, New Orleans, LA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA
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Krüger S, Thaler S, Clauser S, Folchini D, Krause P, Berner L, Pycha A, Palermo S, Comploj E, Trenti E. [Life-threatening complication caused by a neurostimulator]. Aktuelle Urol 2022. [PMID: 36302548 DOI: 10.1055/a-1924-7617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report on a 66-year-old neuro-urological female patient who, three years after implantation of a neurostimulator, experienced cecal necrosis due to strangulation caused by the cable of the device.
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Affiliation(s)
- Sara Krüger
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
| | - Stefanie Thaler
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
| | - Silvia Clauser
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
| | - Decio Folchini
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
| | - Philipp Krause
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
| | - Lucas Berner
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
| | - Armin Pycha
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
- Sigmund Freud Privatuniversität, Medical School, Wien, Österreich
| | | | - Evi Comploj
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
| | - Emanuela Trenti
- Abteilung für Urologie, Landeskrankenhaus Bozen, Bolzano, Italien
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Song XZ, Chu XL, Liu T, Cao YT, Li RX, Gao MW, Li QW, Gu XS, Ming D. Case report: Ultrasound-guided multi-site electroacupuncture stimulation for a patient with spinal cord injury. Front Neurol 2022; 13:903207. [PMID: 36090881 PMCID: PMC9448914 DOI: 10.3389/fneur.2022.903207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Spinal cord injury causes permanent neurological deficits, which have devastating physical, social, and vocational consequences for patients and their families. Traditional Chinese medicine uses acupuncture to treat neuropathic pain and improve nerve conduction velocity. This treatment can also reduce peripheral nerve injury joint contracture and muscle atrophy in affected patients. And it's got a remarkable restoration when electrical stimulation therapy on impaired peripheral nerves in animal models and clinical trials. Case description A 48-year-old woman was hit by a heavy object that injured her lower back. The patient had a T12-L1 vertebral flexion and stretch fracture with traumatic spinal stenosis. The patient was transferred to the rehabilitation department after posterior T12-L2-segment pedicle screw system distraction and reduction, internal fixation, decompression, and bone graft fusion. Ultrasound-guided electroacupuncture was used to stimulate the sacral nerve, the spinal nerve, and the head of the patient, accompanied by spinal joint loosening training, respiratory training, lumbar comprehensive sports training, paraplegic limbs comprehensive training, and other manipulative treatment. Outcomes After the intervention, the patient showed significant improvements in sensory and motor scores, resulting in functional recovery according to ASIA and FIM. The patient gradually showed reasonable functional remission. Discussion The sacral nerve, the spinal cord, and the head were electrically stimulated by ultrasound-guided electroacupuncture in terms of intervention, and various functions of the patient were alleviated to a certain extent. The efficacy of ultrasound-guided electroacupuncture stimulation in treating neurologic symptoms should be validated in future clinical trials.
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Affiliation(s)
- Xi-Zi Song
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xiao-Lei Chu
- Department of Rehabilitation, Tianjin University Tianjin Hospital, Tianjin, China
| | - Tao Liu
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Yu-Tong Cao
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Rui-Xin Li
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Ming-Wei Gao
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Qing-Wen Li
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Xiao-Song Gu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- *Correspondence: Xiao-Song Gu
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Dong Ming
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Amini S, Seche W, May N, Choi H, Tavousi P, Shahbazmohamadi S. Femtosecond laser hierarchical surface restructuring for next generation neural interfacing electrodes and microelectrode arrays. Sci Rep 2022; 12:13966. [PMID: 35978090 PMCID: PMC9385846 DOI: 10.1038/s41598-022-18161-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022] Open
Abstract
Long-term implantable neural interfacing devices are able to diagnose, monitor, and treat many cardiac, neurological, retinal and hearing disorders through nerve stimulation, as well as sensing and recording electrical signals to and from neural tissue. To improve specificity, functionality, and performance of these devices, the electrodes and microelectrode arrays-that are the basis of most emerging devices-must be further miniaturized and must possess exceptional electrochemical performance and charge exchange characteristics with neural tissue. In this report, we show for the first time that the electrochemical performance of femtosecond-laser hierarchically-restructured electrodes can be tuned to yield unprecedented performance values that significantly exceed those reported in the literature, e.g. charge storage capacity and specific capacitance were shown to have improved by two orders of magnitude and over 700-fold, respectively, compared to un-restructured electrodes. Additionally, correlation amongst laser parameters, electrochemical performance and surface parameters of the electrodes was established, and while performance metrics exhibit a relatively consistent increasing behavior with laser parameters, surface parameters tend to follow a less predictable trend negating a direct relationship between these surface parameters and performance. To answer the question of what drives such performance and tunability, and whether the widely adopted reasoning of increased surface area and roughening of the electrodes are the key contributors to the observed increase in performance, cross-sectional analysis of the electrodes using focused ion beam shows, for the first time, the existence of subsurface features that may have contributed to the observed electrochemical performance enhancements. This report is the first time that such performance enhancement and tunability are reported for femtosecond-laser hierarchically-restructured electrodes for neural interfacing applications.
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Affiliation(s)
- Shahram Amini
- Research and Development, Pulse Technologies Inc., Quakertown, PA, 18951, USA. .,Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA.
| | - Wesley Seche
- Research and Development, Pulse Technologies Inc., Quakertown, PA, 18951, USA
| | - Nicholas May
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
| | - Hongbin Choi
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
| | - Pouya Tavousi
- UConn Tech Park, University of Connecticut, Storrs, CT, 06269, USA
| | - Sina Shahbazmohamadi
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
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Gao Z, Liu Y, Zhang L, Yang Z, Lv L, Wang S, Chen L, Zhou N, Zhu Y, Jiang X, Shi B, Li Y. Nociceptor Neurons are Involved in the Host Response to Escherichia coli Urinary Tract Infections. J Inflamm Res 2022; 15:3337-3353. [PMID: 35702548 PMCID: PMC9188809 DOI: 10.2147/jir.s356960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Urinary tract infections (UTIs) can evoke a rapid host immune response leading to bladder inflammation and epithelial damage. Neuroimmune interactions are critical for regulating immune function in mucosal tissues. Yet the role of nociceptor neurons in bladder host defense has not been well defined. This study aimed to explore the interaction between nociceptor neurons and bladder immune system during UTIs. Methods In this study, whether uropathogenic Escherichia coli (UPEC) and lipopolysaccharide (LPS) can directly stimulate nociceptor neurons was detected. Female C57BL/6J mice were treated with high dose of capsaicin, a high-affinity TRPV1 agonist, to ablate nociceptor neurons. Bladder inflammation, barrier epithelial function and bladder immune cell infiltration were assessed after UPEC infection. The level of neuropeptide calcitonin gene-related peptide (CGRP) in infected bladder was detected. Furthermore, the effects of CGRP on neutrophils and macrophages were evaluated both in vitro and in vivo. Results We found that UPEC and its pathogenic factor LPS could directly excite nociceptor neurons, releasing CGRP into infected bladder, which suppressed the recruitment of neutrophils, the polarization of macrophages and the killing function of UPEC. Both Botulinum neurotoxin A (BoNT/A) and BIBN4096 (CGRP antagonism) blocked neuronal inhibition and prevented against UPEC infection. Conclusion The present study showed a novel mechanism by which UPEC stimulated the secretion of CGRP from nociceptor neurons to suppress innate immunity.
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Affiliation(s)
- Zhengdong Gao
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
| | - Yaxiao Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
| | - Lekai Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
| | - Zizhuo Yang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
| | - Linchen Lv
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
| | - Shuai Wang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
| | - Lipeng Chen
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
| | - Nan Zhou
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
| | - Yaofeng Zhu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
- Correspondence: Benkang Shi; Yan Li, Department of Urology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, People’s Republic of China, Email ;
| | - Yan Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
- Key Laboratory of Urinary Precision Diagnosis and Treatment in Universities of Shandong, Jinan, People’s Republic of China
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Closed-loop sacral neuromodulation for bladder function using dorsal root ganglia sensory feedback in an anesthetized feline model. Med Biol Eng Comput 2022; 60:1527-1540. [PMID: 35349032 PMCID: PMC9124066 DOI: 10.1007/s11517-022-02554-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
Overactive bladder patients suffer from a frequent, uncontrollable urge to urinate, which can lead to a poor quality of life. We aim to improve open-loop sacral neuromodulation therapy by developing a conditional stimulation paradigm using neural recordings from dorsal root ganglia (DRG) as sensory feedback. Experiments were performed in 5 anesthetized felines. We implemented a Kalman filter-based algorithm to estimate the bladder pressure in real-time using sacral-level DRG neural recordings and initiated sacral root electrical stimulation when the algorithm detected an increase in bladder pressure. Closed-loop neuromodulation was performed during continuous cystometry and compared to bladder fills with continuous and no stimulation. Overall, closed-loop stimulation increased bladder capacity by 13.8% over no stimulation (p < 0.001) and reduced stimulation time versus continuous stimulation by 57.7%. High-confidence bladder single units had a reduced sensitivity during stimulation, with lower linear trendline fits and higher pressure thresholds for firing observed during stimulation trials. This study demonstrates the utility of decoding bladder pressure from neural activity for closed-loop control of sacral neuromodulation. An underlying mechanism for sacral neuromodulation may be a reduction in bladder sensory neuron activity during stimulation. Real-time validation during behavioral studies is necessary prior to clinical translation of closed-loop sacral neuromodulation.
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Chen W, Fu C, Wu B, Zhou H, Chen E, Wu Q, Yuan J. Efficacy of non‐pharmacological interventions in females with overactive bladder: A systematic review and network meta‐analysis. J Clin Nurs 2022; 32:2399-2409. [PMID: 35434874 DOI: 10.1111/jocn.16325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To compare and rank the effectiveness of non-pharmacological interventions for symptoms of Overactive Bladder (OAB) in network meta-analysis. BACKGROUND Overactive Bladder affects many patients, which often generates bothersome symptoms and debilitates the quality of life. Non-pharmacological therapies have been widely used in OAB. However, due to insufficient evidence, it remains unclear which strategies are most suitable for OAB. METHODS We integrated randomised controlled trials (RCTs), which were searched up to 1 January 2021, from 8 databases (PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc). Studies that met the eligible criteria were assessed the risk of bias. Then, network meta-analyses were conducted by STATA, R, and OpenBUGS. The review followed PRISMA statement. RESULTS A total of 24 studies comprising 2347 patients with OAB were included in this review, most of which were low to moderate risk of bias. The results of network meta-analysis implied that electric stimulation (ES) was the most effective intervention to reduce voided frequency and nocturia frequency of OAB. CONCLUSIONS Electric stimulation ranked the best in the management of OAB, and future studies should pay more attention to ES.
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Affiliation(s)
- Wenzhen Chen
- The School of Nursing Anhui University of Chinese Medicine Hefei China
| | - Chengwei Fu
- The Second Clinical Medical School Guangzhou University of Chinese Medicine Guangzhou China
| | - Boyu Wu
- Hunan University of Chinese Medicine Changsha China
| | | | - Erfei Chen
- The School of Software Engineering University of Science and Technology of China Hefei China
| | - Qionghua Wu
- The first affiliated hospital of Anhui University of Chinese Medicine Hefei China
| | - Juan Yuan
- The School of Nursing Anhui University of Chinese Medicine Hefei China
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11
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Sacral Acupuncture for Lower Urinary Tract Symptoms: A Systematic Review of Randomized Controlled Trials. JOURNAL OF ACUPUNCTURE RESEARCH 2022. [DOI: 10.13045/jar.2021.00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) associated with storage, voiding, and post-micturition reduce quality of life and cause mental health problems. In traditional medicine, Baliao points have been empirically used to treat urinary system diseases. In this review, randomized controlled trials (RCTs) using sacral acupuncture on Baliao points with sham treatment, other remedies, or other acupoints were retrieved from 8 electronic databases up to June 2021. Sixteen RCTs met the inclusion criteria. The quality of the included studies was assessed using a risk-of-bias (ROB) tool. Most of the evaluation indicators used in the included RCTs showed that sacral acupuncture had a significant therapeutic effect compared with the sham control intervention groups, and other remedies. However, all studies using acupoints (other than the Baliao points) as a control intervention had a “high” ROB and only reported secondary processed information, making it difficult to evaluate the efficacy of sacral acupuncture treatment for LUTS. No serious adverse effects were reported for sacral acupuncture, and only a low number of minor side effects were observed. These results suggest that sacral acupuncture could be considered as an alternative to existing treatments, with the added benefit of low cost. Large-scale, long-term RCTs are required in the future.
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12
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The effectiveness of different electrical nerve stimulation protocols for treating adults with non-neurogenic overactive bladder: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:1045-1058. [PMID: 35119495 DOI: 10.1007/s00192-022-05088-7] [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: 10/06/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Electrical nerve stimulation is a widely used treatment for overactive bladder but there is no consensus regarding the best placement of electrodes or protocols. We hypothesised that some non-implanted neurostimulation protocols would be more effective compared to others for treating urinary symptoms and improving quality of life among adults diagnosed with non-neurogenic overactive bladder. METHODS A systematic review and meta-analyses of randomized clinical trials were performed in five electronic databases: PubMed/MEDLINE, Lilacs, CINAHL, Web of Science, and PEDro. The main outcome was urinary symptoms-frequency, nocturia, and urgency-and the secondary outcome quality of life. Some protocol characteristics were extracted, e.g., frequency, pulse width, intensity, intervention time, and electrode placement. RESULTS Nine randomized controlled trials were included. Tibial neurostimulation showed better results than sacral neurostimulation for urge incontinence (mean difference = 1.25 episodes, 95% CI, 0.12-2.38, n = 73). On the pooled analysis, the different neurostimulation protocols-intravaginal, percutaneous tibial, and transcutaneous tibial nerve stimulation-demonstrated similar results for urinary frequency, nocturia, and urgency as well as quality of life. In general, effect sizes from meta-analyses were low to moderate. The best reported parameters for percutaneous tibial nerve stimulation were 20-Hz frequency and 200-μs width, once a week. CONCLUSIONS There was evidence that tibial neurostimulation is more effective than sacral neurostimulation for urge incontinence symptoms among patients with non-neurogenic overactive bladder. Overall, there was no superiority of an electrical nerve stimulation electrode placement and protocol over others considering urinary symptoms and quality of life. Further studies with three-arm trials are necessary. This study was registered at PROSPERO: CRD4201810071.
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Shen JD, Chen SJ, Chen HY, Chiu KY, Chen YH, Chen WC. Review of Animal Models to Study Urinary Bladder Function. BIOLOGY 2021; 10:biology10121316. [PMID: 34943231 PMCID: PMC8698391 DOI: 10.3390/biology10121316] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022]
Abstract
Simple Summary The treatment of urinary bladder dysfunction requires the knowledge of bladder function, which involves physiology, pathology, and even psychology. Several animal models are available to study a variety of bladder disorders. These models include animals from rodents, such as mice and rats, to nonhuman primates, such as rabbits, felines, canines, pigs, and mini pigs. This review adapted animal models to study bladder function according to facility, priority, and disease. Abstract The urinary bladder (UB) serves as a storage and elimination organ for urine. UB dysfunction can cause multiple symptoms of failure to store urine or empty the bladder, e.g., incontinence, frequent urination, and urinary retention. Treatment of these symptoms requires knowledge on bladder function, which involves physiology, pathology, and even psychology. There is no ideal animal model for the study of UB function to understand and treat associated disorders, as the complexity in humans differs from that of other species. However, several animal models are available to study a variety of other bladder disorders. Such models include animals from rodents to nonhuman primates, such as mice, rats, rabbits, felines, canines, pigs, and mini pigs. For incontinence, vaginal distention might mimic birth trauma and can be measured based on leak point pressure. Using peripheral and central models, inflammation, bladder outlet obstruction, and genetic models facilitated the study of overactive bladder. However, the larger the animal model, the more difficult the study is, due to the associated animal ethics issues, laboratory facility, and budget. This review aims at facilitating adapted animal models to study bladder function according to facility, priority, and disease.
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Affiliation(s)
- Jing-Dung Shen
- Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital, Taichung 41168, Taiwan;
- National Defense Medical Center, Taipei 11490, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan;
| | - Szu-Ju Chen
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.C.); (K.-Y.C.)
| | - Huey-Yi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan;
- Department of Obstetrics and Gynecology, Department of Medical Research, Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Kun-Yuan Chiu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.C.); (K.-Y.C.)
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan;
- Department of Obstetrics and Gynecology, Department of Medical Research, Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Correspondence: (Y.-H.C.); (W.-C.C.)
| | - Wen-Chi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan;
- Department of Obstetrics and Gynecology, Department of Medical Research, Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
- Correspondence: (Y.-H.C.); (W.-C.C.)
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Fernández-Cuadros ME, Martín-Martín LM, Albaladejo-Florín MJ, Pérez-Moro OS, Álava-Rabasa S, Goizueta-San-Martín G. [Transcutaneous stimulation of the posterior tibial nerve modifies the sympathetic skin response and improves overactive bladder syndrome: Case series and possible diagnostic test]. Rehabilitacion (Madr) 2021; 56:255-263. [PMID: 34565565 DOI: 10.1016/j.rh.2021.04.005] [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: 01/03/2021] [Revised: 03/05/2021] [Accepted: 04/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE (a) To assess the effect of transcutaneous neuromodulation (TNM) of the posterior tibial nerve plus biofeedback on the sympathetic skin response (SSR). (b) Evaluate its effect on clinical symptoms. (c) Consider SSR as a probable neurophysiological test useful both for diagnosis and for follow-up in patients with overactive bladder (OAB). (d) Evaluate its cost compared to other techniques. MATERIAL AND METHODS A prospective quasi-experimental before and after study in 10 OAB patients. OUTCOME VARIABLES daytime (DUF) and nighttime (NUF) urinary frequency, strength of the pelvic floor muscles measured by manometry (maximum and mean pressure) and sympathetic skin response (SSR). RESULTS DUF improved from 10.3±5.45 to 5.9±2.42 episodes (P=.0050). The NUF improved from 2.4±1.5 to 0.6±0.69 episodes (P=.0012). The maximum pressure ranged from 34.7±16.51 to 39.7±3.65mmHg (P=.0195). The mean pressure of the pelvic floor muscles improved from 6.6±3.65 to 9.3±5.43mmHg (P=.0333). SSR changed from 100% hyperexcitability prior to treatment to 50±14.14% (P=.0000). CONCLUSION TNM plus biofeedback could modify SSR and improve clinical and manometry variables in a series of patients with OAB. The probable diagnostic and prognostic utility of this neurophysiological test in OAB and detrusor hyperactivity is reported for the first time. A larger sample study is needed to confirm the promising findings seen in this preliminary study.
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Affiliation(s)
- M E Fernández-Cuadros
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España.
| | - L M Martín-Martín
- Servicio de Neurofisiología Clínica, Hospital Universitario Santa Cristina, Madrid, España
| | - M J Albaladejo-Florín
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
| | - O S Pérez-Moro
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
| | - S Álava-Rabasa
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
| | - G Goizueta-San-Martín
- Servicio de Neurofisiología Clínica, Hospital Universitario Santa Cristina, Madrid, España
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Bakrim N, Chabannes É, Detree P, Balssa L, Wagner L, Kleinclauss F. [Sacral neuromodulation as treatment of non-neurological vesical emptying disorders]. Prog Urol 2021; 32:14-22. [PMID: 34332832 DOI: 10.1016/j.purol.2021.06.004] [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: 03/11/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
GOAL The goal was to evaluate the results of sacral neuromodulation (SNM) in non-neurological vesical emptying disorders. PATIENTS AND METHODS From February 2010 to October 2017, 28 patients presenting voiding symptoms or a non-obstructive chronic urine retention without neurological cause have been operated for an SNM (test phase). The test was positive in case of decreased number of proper intermittent self-catheterization (SC) or post-voiding residual urine (PVR) of at least 50 %. A 100 % positive result meant the return to a spontaneous voiding without SC with a non-significative PVR (<100ml). RESULTS The median follow-up was of 53.2±21.2 months. Twenty-four (85.7%) tests were positive, from which twenty-two (78.6%) were 100% positive. 16 (84.2%) out of 19 patients with SC had spontaneous voiding without PVR. The number of daily SC decreased from 4.6±1.5 to 0.4±1.2 in post-operative (P<0.001). The PVR was of 287.1±170.4ml vs. 30.4±48.6ml in post-operative (P<0.001). Fourteen patients (58.3%) underwent at least one chirurgical revision or a removal of material ; mainly for loss of efficiency, end of battery, electrode migration and pain on material. At the end of the follow-up, 70.8% of the responding patients had their device still efficient. CONCLUSION Results showed that SNM appears to be an efficient treatment of non-neurological emptying vesical troubles. Nevertheless, the re-operation rate was still significant. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- N Bakrim
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France; Université de Franche Comte, Besançon, France.
| | - É Chabannes
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - P Detree
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - L Balssa
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France
| | - L Wagner
- Service d'urologie andrologie, CHU Caremeau, Nîmes, France
| | - F Kleinclauss
- Service d'urologie andrologie et transplantation rénale, CHRU Minjoz, Besançon, France; Université de Franche Comte, Besançon, France; Nanomedicine Lab, Imagery and Therapeutics", EA 4662, Besancon, France
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Wang A, Rourke E, Sebesta E, Dmochowski R. Axonics® system for treatment of overactive bladder syndrome and urinary urgency incontinence. Expert Rev Med Devices 2021; 18:727-732. [PMID: 34187274 DOI: 10.1080/17434440.2021.1947794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Overactive bladder and urge urinary incontinence affect millions of women and men and results in billions of dollars in health-care expenses. First- and second-line therapy includes behavioral modifications and/or pharmacotherapies however, many patients' symptoms remain or progress on these treatments. There has been concern regarding the detrimental side effects of the most widely prescribed medications for these bladder symptom management.Areas covered: As a result, there has been increased interest in continuous sacral neuromodulation, an FDA approved therapy for refractory urinary urgency and urge urinary incontinence. In this article, we specifically review current research on the efficacy and patient/provider satisfaction and safety profile of the Axonics® System. In addition, we address the current state of sacral neuromodulation and potential future direction and applicability.Expert opinion: The Axonics® system is a safe effective device for the treatment of overactive bladder and urinary urge incontinence. Additionally, it affords patient's the convenience of a rechargeable, compact, MRI safe system. It should be noted that the rechargeable system, while allowing for approximately 15 years of battery and lead life, may have its challenges in terms of charge burden. Furthermore, this system is easily adapted for experienced implanters of sacral neuromodulating devices.
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Affiliation(s)
- Alice Wang
- Department of Urology, Vanderbilt University Medical Center Nashville, Nashville, TN, USA
| | - Elizabeth Rourke
- Department of Urology, Vanderbilt University Medical Center Nashville, Nashville, TN, USA
| | - Elisabeth Sebesta
- Department of Urology, Vanderbilt University Medical Center Nashville, Nashville, TN, USA
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center Nashville, Nashville, TN, USA
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Msika J, Kalantan M, Larre S, Leon P. [Functional results and satisfaction in 44 patients after implantation of a NS3-type sacral neurostimulator for refractory idiopathic overactive bladder followed at 43 months, single-center series]. Prog Urol 2021; 31:725-731. [PMID: 33962849 DOI: 10.1016/j.purol.2020.11.007] [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: 07/31/2020] [Revised: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Sacred neuromodulation (SNM) has been used in France since 1997 for the management of non-neurogenic urinary disorders that do not respond to first-line pharmacological treatment. The aim of this study is to analyze the clinical efficacy and satisfaction of patients with refractory idiopathic overactive bladder (OAB) treated with SNM. METHODS This single-center retrospective series included 59 patients with refractory OAB of idiopathic origin and eligible for the SNM between January 2010 and December 2017. Demographic data, history of pelvic surgery, complications according to Clavien-Dindo classification, as well as revision and explantation rates were collected. All the patients included underwent a test phase. Therapeutic success for the test phase and definitive implantation was defined by≥50% improvement. Satisfaction was a secondary criteria. RESULTS Of the 59 patients tested for SNM, 44 patients had a permanent implantation, of which 36 (82%) were women and 8 (12%) were men. The median age of the study was 55 years old. The median follow-up was 43 months [21,2-66,5]. All of the patients had an idiopathic refractory OAB. The median time between test and final implantation was 28 days [18-35]. The success rate for all patients tested was 60% (34/59). In patients implanted, 34 patients (77%) had clinical improvement. Adverse events had to be managed including multiple re-parameterizations (n=13), device revision (n=16), or even device implantation (n=8). The satisfaction rate was 82% (36/44). CONCLUSION With a median follow-up of 43 months, this retrospective study on NMS shows the efficacy of second-line SNM for idiopathic OAB. This technique remains minimally invasive but with significant adverse events when informing our patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- J Msika
- Service d'urologie, CHU Robert-Debré, 51100 Reims, France.
| | - M Kalantan
- Service d'urologie, CHU Robert-Debré, 51100 Reims, France
| | - S Larre
- Service d'urologie, CHU Robert-Debré, 51100 Reims, France
| | - P Leon
- Service d'urologie, Clinique Pasteur, 17200 Royan, France
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Zhou B, Ma D, Yu H, Han B, Pang R. Acupuncture for acontractile bladder: a case report. Acupunct Med 2021; 39:716-717. [PMID: 33896227 DOI: 10.1177/09645284211009903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bingying Zhou
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Diyuan Ma
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huibo Yu
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baojin Han
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ran Pang
- Department of Urology, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Lee Y, Lee C, Wang EJ, Kotov D, Kim HY, Hwang JH, Ahn KH, Lee SH. Non-Invasive Ring Electrode With a Wireless Electrical Recording and Stimulating System for Monitoring Preterm Labor. IEEE Trans Neural Syst Rehabil Eng 2021; 28:2627-2636. [PMID: 33085610 DOI: 10.1109/tnsre.2020.3032742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Preterm labor and birth are the primary causes of neonatal morbidities and mortalities. The early detection and treatment of preterm uterine muscular contraction are crucial for the management of preterm labor. In this work, a ring electrode with a wireless electrical recording and stimulating (RE-WERS) system was designed, fabricated, and investigated for the non-invasive monitoring of uterine contraction/relaxation as a diagnostic and therapeutic tool for preterm labor. By using an organ bath system, we confirmed that the uterine contraction force in mice can be decreased by the application of electrical stimulation. Then, the RE-WERS system was inserted non-invasively through the vagina to the cervix of a pregnant minipig, and it successfully recorded the uterine contraction and reflect signals when various electrical stimulating conditions were applied. The difference in the uterine signals before and after the injection of a labor induction drug, such as oxytocin and prostaglandin [Formula: see text], was recorded, and the difference was remarkable. In addition, the uterine signal that was recorded was well matched with the signal of the electromyography (EMG) kit during open abdominal surgery. It seemed that the continuous and various electrical stimulations affected the delay or inhibition of childbirth in the pregnant minipig.
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20
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Greenberg DR, Sohlberg EM, Zhang CA, Santini VE, Comiter CV, Enemchukwu EA. Sacral Nerve Stimulation in Parkinson's Disease Patients With Overactive Bladder Symptoms. Urology 2020; 144:99-105. [PMID: 32681915 DOI: 10.1016/j.urology.2020.06.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the efficacy, safety, and outcomes of sacral nerve stimulation (SNS) for Parkinson's disease (PD) patients with overactive bladder symptoms. METHODS We retrospectively reviewed PD patients who underwent Stage I SNS. Demographics, urodynamic data, and baseline voiding function were analyzed. Efficacy and safety of treatment were determined by rate of progression to Stage II, explantation, and surgical revision. Long-term outcomes were assessed using voiding diaries and/or clinic notes. RESULTS Sixty percent (9/15) experienced ≥50% improvement in urinary parameters and proceeded to Stage II. There was no significant difference in age, body mass index, comorbidities, PD disease duration, or levodopa equivalent daily dose between successful and nonsuccessful Stage I patients. However, 100% of female patients experienced Stage I success compared to 44% of male PD patients (P = .04). Individuals with >12-month follow-up experienced an average reduction of 6 voids/day. No patients required revision or explantation of their device at latest clinic follow-up (22.2 ± 7.8 months). Higher maximal urethral closure pressures, detrusor pressure at maximum flow rate (PdetQmax), post-void residual volume, and mean bladder outlet obstruction index were observed in the Stage I trial failures. CONCLUSION At our institution, PD patients have a similar rate of progression to Stage II compared to the general population. SNS is an effective therapy that should be considered among the treatment options for PD patients with overactive bladder symptoms. Urodynamic parameters associated with obstruction may be predictive of SNS failure in PD patients and may help guide patient selection, however further studies are needed.
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Affiliation(s)
- Daniel R Greenberg
- Stanford University School of Medicine, Department of Urology, Stanford, CA.
| | - Ericka M Sohlberg
- Stanford University School of Medicine, Department of Urology, Stanford, CA
| | - Chiyuan A Zhang
- Stanford University School of Medicine, Department of Urology, Stanford, CA
| | - Veronica E Santini
- Stanford University School of Medicine, Department of Neurology and Neurological Sciences, Stanford, CA
| | - Craig V Comiter
- Stanford University School of Medicine, Department of Urology, Stanford, CA
| | - Ekene A Enemchukwu
- Stanford University School of Medicine, Department of Urology, Stanford, CA
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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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Evaluation of pre-operative bladder contractility as a predictor of improved response rate to a staged trial of sacral neuromodulation in patients with detrusor underactivity. World J Urol 2020; 39:2113-2119. [PMID: 32725304 DOI: 10.1007/s00345-020-03380-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Sacral neuromodulation (SNM) is one of the few management options shown to improve outcomes in patients with detrusor underactivity (DU). This original research will investigate if preserved bladder contractility can predict a successful treatment with SNM. METHODS This is a retrospective study of a prospectively collected database of consecutive patients with DU, who had a staged SNM trial from January 2013 to December 2018, with a minimum of 12 months follow-up. The primary outcome was the success of stage 1 SNM trial. RESULTS In total, 69 patients with DU were followed. The median age was 67 [interquartile range (IQR) 74-55], median baseline bladder contractility index (BCI) 18 (IQR 67-0), and median post-void residual 200 mL (IQR 300-130). There were 35 patients (51%) that responded to a SNM trial. At a median follow-up of 23 months (IQR 39-12), three were removed for poor efficacy. In patients with detrusor acontractility (DAC), six responded (33%), compared to 29 patients (57%) with BCI > 0. This was statistically significant, p value 0.03. Younger age was also a predictive factor for SNM response, p value 0.02. There were no differences noted in those with gender, neurogenic history, previous pelvic surgery, diabetes, or pre-operative voiding history. CONCLUSION Our study showed that patients with preserved bladder contractility are more likely to respond to a trial of SNM compared with those that have DAC. Younger age was also predictive of SNM response. UDS is the only method to accurately identify DAC patients. This information will help in patient selection and pre-operative counselling.
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Meng LF, Zhang W, Wang JY, Zhang YG, Zhang P, Liao LM, Lv JW, Ling Q, Wei ZQ, Zhong T, Xu ZH, Wen W, Li JY, Luo DY. Clinical outcomes of sacral neuromodulation in non-neurogenic, non-obstructive dysuria: A 5-year retrospective, multicentre study in China. World J Clin Cases 2020; 8:2494-2501. [PMID: 32607326 PMCID: PMC7322430 DOI: 10.12998/wjcc.v8.i12.2494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/08/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Management of non-neurogenic, non-obstructive dysuria represents one of the most challenging dilemmas in urological practice. The main clinical symptom is the increase in residual urine. Voiding dysfunction is the main cause of dysuria or urinary retention, mainly due to the decrease in bladder contraction (the decrease in contraction amplitude or duration) or the increase in outflow tract resistance. Sacral neuromodulation (SNM) has been used for > 10 years to treat many kinds of lower urinary tract dysfunction. It has become increasingly popular in China in recent years. Consequently, studies focusing on non-neurogenic, non-obstructive dysuria patients treated by SNM are highly desirable.
AIM To assess the outcome of two-stage SNM in non-neurogenic, non-obstructive dysuria.
METHODS Clinical data of 54 patients (26 men, 28 women) with non-neurogenic, non-obstructive dysuria treated by SNM from January 2012 to December 2016 in ten medical centers in China were retrospectively analyzed. All patients received two or more conservative treatments. The voiding diary, urgency score, and quality of life score before operation, after implantation of tined lead in stage I (test period), and during short-term follow-up (latest follow-up) after implantation of the implanted pulse generator in stage II were compared to observe symptom improvements.
RESULTS Among the 54 study patients, eight refused to implant an implanted pulse generator because of the unsatisfactory effect, and 46 chose to embed the implanted pulse generator at the end of stage I. The conversion rate of stage I to stage II was 85.2%. The average follow-up time was 18.6 mo. There were significant differences between baseline (before stage I) and the test period (after stage I) in residual urine, voiding frequency, average voiding amount, maximum voiding amount, nocturia, urgency score, and quality of life score. The residual urine and urgency score between the test period and the latest follow-up time (after stage II) were also significantly different. No significant differences were observed for other parameters. No wound infection, electrode breakage, or other irreversible adverse events occurred.
CONCLUSION SNM is effective for patients with non-neurogenic, non-obstructive dysuria showing a poor response to traditional treatment. The duration of continuous stimulation may be positively correlated with the improvement of residual urine.
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Affiliation(s)
- Ling-Feng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Wei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Yao-Guang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Peng Zhang
- Department of Urology, Beijing Chaoyang Hospital, Institute of Urology, Capital Medical University, Beijing 100000, China
| | - Li-Min Liao
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing 100000, China
| | - Jian-Wei Lv
- Department of Urology, South Campus, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Zhong-Qing Wei
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
| | - Tie Zhong
- Department of Urology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710000, Shaanxi Province, China
| | - Zhi-Hui Xu
- Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Wei Wen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
| | - Jia-Yi Li
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
| | - De-Yi Luo
- Department of Urology, West China Hospital, Sichuan University, Chengdu 610000, Sichuan Province, China
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Laser Acupuncture Alleviates Symptoms and Improves Quality of Life in Women with Overactive Bladder: A Double-Blind, Pilot Randomized Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:1705964. [PMID: 32419791 PMCID: PMC7201846 DOI: 10.1155/2020/1705964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to investigate the clinical efficacy of laser acupuncture for the treatment of women with overactive bladder (OAB) in Taiwan. Methods A double-blind randomized controlled trial was conducted on female patients with OAB symptoms referred from gynecologists, and subjects were divided into two groups using blocked randomization. LaserPan (RJ-Laser, Germany) was applied to seven selected acupuncture points. The subjects received laser acupuncture 3 times per week for 3 weeks, 9 sessions in total. Basic patient data, Overactive Bladder Symptom Score (OABSS), Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6) scores were recorded prior to first treatment and at the end of 3rd, 6th, and 9th treatments. Results Thirty patients were enrolled, and twenty-seven patients completed all treatments in this study. The OABSS total score of the experimental group decreased significantly by 3.13 (p ≤ 0.001), 4.60 (p ≤ 0.001), and 3.79 (p ≤ 0.001) after 3rd, 6th, and 9th treatments, respectively, compared with that of the control group. The IIQ-7 score declined significantly from baseline by 4.57 (p=0.003) and 3.63 (p=0.023) after 3rd and 6th treatments, respectively, compared with that of the control group. Similarly, the UDI-6 score of the experimental group exhibited a significant decrease from baseline by 1.90 (p=0.042) and 2.25 (p=0.025) after 6th and 9th interventions, respectively, compared with that of the control group. Conclusions This study demonstrates that laser acupuncture can alleviate OAB symptoms and improve quality of life. This noninvasive device could be an effective therapy for women with OAB.
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Do Failure of Posterior Tibial Nerve Stimulation Precludes to Use Sacral Neuromodulation in Patient With Overactive Bladder? Int Neurourol J 2020; 23:287-293. [PMID: 31905275 PMCID: PMC6944783 DOI: 10.5213/inj.1938118.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/29/2019] [Indexed: 01/27/2023] Open
Abstract
Purpose To evaluate the outcomes of sacral neuromodulation (SNM) after failure of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with overactive bladder (OAB). Methods A retrospective study was conducted in 3 university hospitals and included all patients with OAB and treated with SNM after TPTNS had been tried between October 2008 and May 2018. The primary endpoint was the proportion of definitive SNM device implantation in patients with 50% objective and/or subjective improvement after a test period (stage 1). The secondary outcomes of interest were changes of the number of diurnal voids and nocturia episodes per 24 hours between the end of TPTNS and the end of stage 1. Results Overall, 28 of the 43 patients included achieved at least 50% objective and/or subjective improvement during stage 1 and underwent an Interstim II implantation (65.1%). The mean daytime frequency decreased significantly from 10.3/day at the end of TPTNS to 7.8 diurnal voids/day at the end of SNM stage 1 (P=0.01). The mean number of nocturia episodes decreased from 2.5/night at the end of TPTNS to 2.1/night at the end of stage 1, but this did not reach statistical significance (P=0.18). There was no other parameter significantly associated with response to SNM Conclusions SNM might improve OAB symptoms in most patients who experienced no or poor efficacy with TPTNS. History of failed TPTNS should not preclude the use of SNM in OAB patients.
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Pennycuff JF, White J, Park AJ. Treatment of Refractory Urinary Urgency, Frequency, and Incontinence in Pregnancy. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00533-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gevelinger MM, Sanderson DJ, Jaworski E, Doyle PJ. Evaluation of Sacral Nerve Stimulation Device Revision and Explantation in a Single Center, Multidisciplinary Study. Neuromodulation 2019; 23:1201-1206. [DOI: 10.1111/ner.13050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Matthew M. Gevelinger
- Department of Obstetrics and Gynecology University of Rochester, School of Medicine and Dentistry Rochester NY USA
| | - Derrick J. Sanderson
- Department of Obstetrics and Gynecology University of Rochester, School of Medicine and Dentistry Rochester NY USA
| | - Elaine Jaworski
- School of Medicine and Dentistry University of Rochester Rochester NY USA
| | - Paula J. Doyle
- School of Medicine and Dentistry, Department of Obstetrics and Gynecology, Department of Urology University of Rochester Rochester NY USA
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Outcomes of Intradetrusor Onabotulinum Toxin A Therapy in Overactive Bladder Refractory to Sacral Neuromodulation. Int Neurourol J 2019; 23:226-233. [PMID: 31607102 PMCID: PMC6790822 DOI: 10.5213/inj.1938030.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/04/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose Intradetrusor onabotulinum toxin A (BTXA) and sacral neuromodulation (SNM) are effective third-line therapies for overactive bladder (OAB). We aimed to measure the outcomes of BTXA for treatment of OAB refractory to initial SNM and identify patient characteristics associated with these outcomes. Methods This retrospective cohort study included patients who failed to respond to initial SNM treatment for OAB and subsequently received BTXA at a single provider’s clinic between January 2013 and December 2016. Treatment successes were defined as patients willing to continue BTXA or who found symptom relief whereas treatment failures discontinued BTXA due to adverse effects or lack of symptom relief. Symptoms and patient-reported outcomes on validated questionnaires were compared before the initial BTXA trial to 2 months after the last BTXA treatment. The SNM failure BTXA groups were also compared to BTXA SNM naïve groups. Results Of 18 patients who received BTXA after failed SNM treatment, 7 (39%) achieved treatment success. Successfully treated patients demonstrated decreased urinary frequency from a median 11 voids/day pre-BTXA to 8 voids/day with BTXA (P=0.042). Patients whose treatment failed reported increased complaints of a weak urinary stream (P=0.03) and higher frequency of straining to urinate (P=0.016) than the successful treatment group pre-BTXA. Compared to BTXA patients without prior SNM, the odds of failing BTXA after initial SNM were 3.6 times higher (P=0.016). Conclusions BTXA appears effective for OAB refractory to SNM, although the success rate is lower compared to BTXA patients without SNM exposure.
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A comparison of sacral neuromodulation vs. transvaginal electrical stimulation for the treatment of refractory overactive bladder: the impact on quality of life, body image, sexual function, and emotional well-being. MENOPAUSE REVIEW 2019; 18:89-93. [PMID: 31485205 PMCID: PMC6719634 DOI: 10.5114/pm.2019.86834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/17/2019] [Indexed: 02/04/2023]
Abstract
Overactive bladder syndrome (OAB) is defined by the presence of urinary urgency, with or without urge incontinence, usually accompanied by an increase in urinary frequency and nocturia in the absence of urinary tract infections (UTI) or other diseases. The overall prevalence of OAB symptoms in the female population is reported to be 16.6% and increases with advancing age and menopause. The aetiology of OAB is not fully understood and is likely to affect a heterogeneous population of patients due to changes to their central and peripheral nervous systems. Although OAB is frequently associated with female sexual dysfunction (FSD), its real impact on sexual function in women has been evaluated only in a few studies. The first line of treatment for OAB includes behavioural modification and physical therapy, either as monotherapies or in combination. Many patients who have not had success in managing their symptoms with more conservative therapies may decide to resort to third-line treatments for refractory OAB. These treatments include neuromodulation therapies, particularly transvaginal electrical stimulation (TES) and sacral neuromodulation (SN). The aim of this short commentary is to provide an overview of the effectiveness of these treatments and of their impact on quality of life, body image, sexual function, and emotional well-being.
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Roy HA, Green AL. The Central Autonomic Network and Regulation of Bladder Function. Front Neurosci 2019; 13:535. [PMID: 31263396 PMCID: PMC6585191 DOI: 10.3389/fnins.2019.00535] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/08/2019] [Indexed: 12/30/2022] Open
Abstract
The autonomic nervous system (ANS) is involved in the regulation of physiologic and homeostatic parameters relating particularly to the visceral organs and the co-ordination of physiological responses to threat. Blood pressure and heart rate, respiration, pupillomotor reactivity, sexual function, gastrointestinal secretions and motility, and urine storage and micturition are all under a degree of ANS control. Furthermore, there is close integration between the ANS and other neural functions such as emotion and cognition, and thus brain regions that are known to be important for autonomic control are also implicated in emotional functions. In this review we explore the role of the central ANS in the control of the bladder, and the implications of this for bladder dysfunction in diseases of the ANS.
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Affiliation(s)
- Holly Ann Roy
- Department of Neurosurgery, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - Alexander L Green
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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Tibial Nerve and Sacral Neuromodulation in the Elderly Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Understanding the pathophysiologic mechanisms responsible for overactive bladder (OAB) and urgency urinary incontinence (UUI) is critical to advancing the treatment options available to men and women with this prevalent and bothersome condition. Development of novel technologies and advanced functional neuroimaging modalities has provided us with new information to support and refine existing mechanistic theories. Emerging research on central pathophysiologic mechanisms of OAB from functional magnetic resonance imaging may provide new targets for therapeutic interventions and opens the door for novel treatment strategies. Several regions of interest—specifically the anterior cingulate gyrus, insula, and frontal cortices—have been implicated as areas of activation in women with OAB, suggesting a neural correlate of the experience of urgency. The cerebellum and parietal lobe have demonstrated increased activation during inhibition of voiding, and increased connectivity between the cerebellum and parietal lobe and the right insula and anterior cingulate gyrus has been demonstrated in women with UUI compared with controls. Evolving literature is beginning to shed light on the prerequisite effective connections between regions of interest in the healthy bladder and negative connectivity in OAB and UUI. Precision medicine with individualized care pathways may better select available treatment modalities for rightful recipients, thus improving efficacy with prescribed treatment approaches and adherence to therapy.
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Affiliation(s)
- Ariana L Smith
- Division of Urology, University of Pennsylvania , Philadelphia, PA, USA
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Neuromodulation des racines sacrées : indications et modalités thérapeutiques. Prog Urol 2018; 28:767-771. [DOI: 10.1016/j.purol.2018.07.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022]
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Jairam R, Drossaerts J, Marcelissen T, van Koeveringe G, van Kerrebroeck P. Onset of Action of Sacral Neuromodulation in Lower Urinary Tract Dysfunction—What is the Optimal Duration of Test Stimulation? J Urol 2018; 199:1584-1590. [DOI: 10.1016/j.juro.2017.12.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ranjana Jairam
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Philip van Kerrebroeck
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Dekopov AV, Tomskiy AA, Salyukov RV, Salyukova YR, Machevskaya OE, Kadyrov SU. [Chronic sacral nerve electrostimulation in treatment of neurogenic pelvic organ dysfunction in children]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018; 82:107-111. [PMID: 29795094 DOI: 10.17116/oftalma2018822107-111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Myelodysplasia is the most common cause of congenital pelvic abnormalities in children. The causes of acquired neurogenic pelvic dysfunctions in children include spinal cord injury, myelitis, and neurodegenerative diseases. Urination impairments in children with neurological disorders are a serious clinical problem. In most cases, the capabilities of conservative treatment of pelvic organ dysfunctions are limited. One of the most promising directions in treatment of neurogenic urination disorders is modeling of a lost urination mechanism using direct or mediated electrostimulation of the nerve fibers of the sacral plexus - neuromodulation. AIM the review aim is to describe the technique and results of chronic sacral neurostimulation in treatment of pelvic organ disorders in children, which have been reported in the international literature. An obligatory condition for application of chronic sacral neurostimulation (CSNS) is a positive clinical response to test electrostimulation of the S3 nerve root. The test period duration is 1-3 weeks. In the case of a positive effect, a permanent system is implanted for neurostimulation of the S3 nerve root. On treatment with CSNS, children with severe urinary incontinence had a significant decrease in the rate of incontinence episodes, and patients with urinary retention had no or reduced need for periodic catheterization. Therefore, the accumulated experience of using CSNS in children with spinal cord diseases indicates the need in further study of the technique capabilities for correction of pelvic organ dysfunctions.
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Affiliation(s)
- A V Dekopov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - A A Tomskiy
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - R V Salyukov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - Yu R Salyukova
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - O E Machevskaya
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - Sh U Kadyrov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
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Wyndaele JJ, Birch B, Borau A, Burks F, Castro-Diaz D, Chartier-Kastler E, Drake M, Ishizuka O, Minigawa T, Opisso E, Peters K, Padilla-Fernández B, Reus C, Sekido N. Surgical management of the neurogenic bladder after spinal cord injury. World J Urol 2018; 36:1569-1576. [DOI: 10.1007/s00345-018-2294-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/05/2018] [Indexed: 10/17/2022] Open
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Weissbart SJ, Bhavsar R, Rao H, Wein AJ, Detre JA, Arya LA, Smith AL. Specific Changes in Brain Activity during Urgency in Women with Overactive Bladder after Successful Sacral Neuromodulation: A Functional Magnetic Resonance Imaging Study. J Urol 2018; 200:382-388. [PMID: 29630979 DOI: 10.1016/j.juro.2018.03.129] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE The mechanism of sacral neuromodulation is poorly understood. We compared brain activity during urgency before and after sacral neuromodulation in women with overactive bladder and according to the response to treatment. MATERIALS AND METHODS Women with refractory overactive bladder who elected sacral neuromodulation were invited to undergo functional magnetic resonance imaging before and after treatment. During imaging the bladder was filled until urgency was experienced. Regions of interest were identified a priori and brain activity in these regions of interest was compared before and after treatment as well as according to the treatment response. Whole brain exploratory analysis with an uncorrected voxel level threshold of p <0.001 was also performed to identify additional brain regions which changed after sacral neuromodulation. RESULTS Of the 12 women who underwent a pretreatment functional magnetic resonance imaging examination 7 were successfully treated with sacral neuromodulation and underwent a posttreatment examination. After sacral neuromodulation brain activity decreased in the left anterior cingulate cortex, the bilateral insula, the left dorsolateral prefrontal cortex and the bilateral orbitofrontal cortex (each p <0.05). No new brain regions showed increased activity after sacral neuromodulation. Pretreatment brain activity levels in the bilateral anterior cingulate cortex, the right insula, the bilateral dorsolateral prefrontal cortex, the right orbitofrontal cortex, the right supplementary motor area and the right sensorimotor cortex were higher in women who underwent successful treatment (each p <0.05). CONCLUSIONS Brain activity during urgency changes after successful sacral neuromodulation. Sacral neuromodulation may be more effective in women with higher levels of pretreatment brain activity during urgency.
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Affiliation(s)
- Steven J Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, New York.
| | - Rupal Bhavsar
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Hengyi Rao
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alan J Wein
- Division of Urology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John A Detre
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lily A Arya
- Department of Obstetrics and Gynecology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, Philadelphia, Pennsylvania
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Kim DK. Current pharmacological and surgical treatment of underactive bladder. Investig Clin Urol 2017; 58:S90-S98. [PMID: 29279881 PMCID: PMC5740035 DOI: 10.4111/icu.2017.58.s2.s90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
Generally accepted guidelines are not yet available on the management of underactive bladder (UAB). Although the natural history of UAB is still not fully understood, observation may be an acceptable management option in patients with tolerable lower urinary tract symptoms and little risk of upper urinary tract damage. If needed, scheduled and double voiding may be recommended as an effective and safe add-on therapy. Parasympathomimetics have been widely used for the management of UAB, but the evidence does not support clinical benefit. The efficacy of alpha-blockers has also not yet been clearly demonstrated. However, selective alpha-blockers may help to enhance voiding efficiency and to decrease possible upper tract damage. Sacral neuromodulation is a surgical option for nonobstructive UAB approved by the Food and Drug Administration. However, the response rate of test stimulation is not high and the efficacy of permanent implants does not always coincide with that of test stimulation. Although surgery to reduce outlet resistance may be a viable option in UAB with presumed obstruction, surgery seems to have little role in those without obstruction. Latissimus dorsi detrusor myoplasty has shown promising results in restoring voluntary voiding in selected patients. The procedure requires a multidisciplinary team approach of urologists and plastic reconstructive experts. In summary, current treatments of UAB remain unsatisfactory. The multifactorial nature of UAB pathogenesis complicates the appropriate management for each patient. Future research to establish a more clinically relevant definition of UAB will be required to open new era of UAB management.
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Affiliation(s)
- Dae Kyung Kim
- Department of Urology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Abstract
OBJECTIVE Fecal incontinence (FI) has a devastating effect on the quality of life and results in social isolation. Sacral neuromodulation (SNM) is proven to be an effective, minimal invasive treatment modality for FI. Despite the increasing application of SNM, the exact mechanisms of action remain unclear. The initial assumption of peripheral motor neurostimulation is not supported by increasing evidence, which report effects of SNM outside the pelvic floor. A new hypothesis states that afferent signals to the brain are essential for a successful therapy. This study aimed to review relevant studies on the central mechanism of SNM in FI. METHODS Clinical and experimental studies on the central mechanisms, both brain and spinal cord, of SNM for FI up to December 2015 were evaluated. RESULTS In total, 8 studies were found describing original data on the central mechanism of SNM for FI. Four studies evaluated the central effects of SNM in a clinical setting and 4 studies evaluated the central effects of SNM in an experimental animal model. Results demonstrated a variety of (sub)cortical and spinal changes after induction of SNM. CONCLUSION Review of literature demonstrated evidence for a central mechanism of action of SNM for FI. The corticoanal pathways, brainstem, and specific parts of the spinal cord are involved.
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Abstract
The underactive bladder (UAB)/detrusor underactivity (DU) is a relatively common condition. It is difficult to diagnose and can be difficult to manage. The aim of this review is to provide a review of the diagnosis and different surgical treatment options for UAB/DU. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, UAB, DU, TURP, reduction cystoplasty, bladder diverticulectomy and sacral neuromodulation (SNM). Search results were assessed for their overall relevance to this review. Definitions, general overview and management options were extracted from the relevant medical literature. DU affects up to 45% of men and women >70 years of age. The symptoms of DU overlap significantly with overactive bladder (OAB) and bladder outlet obstruction (BOO). Urodynamic findings include low voiding pressure combined with slow intermittent flow and incomplete bladder emptying. Non-operative management for DU is acceptable; only 1 in 6 male patients may need a TURP and acute urinary retention (AUR) is rare. TURP for DU is feasible and is associated with good short and medium term outcomes, but over time, there is a return to baseline symptoms. Bladder diverticulectomy can also improve DU, but there is a paucity of guidelines on patient selection. SNM provides excellent outcomes for DU, but patient selection is important.
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Affiliation(s)
- Johan Gani
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Derek Hennessey
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
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Yu T, Liao L, Wyndaele JJ. Can intraurethral stimulation inhibit micturition reflex in normal female rats? Int Braz J Urol 2017; 42:608-13. [PMID: 27286128 PMCID: PMC4920582 DOI: 10.1590/s1677-5538.ibju.2015.0135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/21/2015] [Indexed: 11/29/2022] Open
Abstract
Objective The study was designed to determine the effect of low frequency (2.5Hz) intraurethral electrical stimulation on bladder capacity and maximum voiding pressures. Materials and Methods The experiments were conducted in 15 virgin female Sprague-Dawley rats (220–250g). The animals were anesthetized by intraperitoneal injection of urethane (1.5g/kg). Animal care and experimental procedures were reviewed and approved by the Institutional Animal Care and Use Committee of Antwerp University (code: 2013-50). Unipolar square pulses of 0.06mA were used to stimulate urethra at frequency of 2.5Hz (0.2ms pulse width) in order to evaluate the ability of intraurethral stimulation to inhibit bladder contractions. Continuous stimulation and intermittent stimulation with 5sec ‘‘on’’ and 5sec ‘‘off’’ duty cycle were applied during repeated saline cystometrograms (CMGs). Maximum voiding pressures (MVP) and bladder capacity were investigated to determine the inhibitory effect on bladder contraction induced by intraurethral stimulation. Results The continuous stimulation and intermittent stimulation significantly (p<0.05) decreased MVP and increased bladder capacity. There was no significant difference in MVP and bladder capacity between continuous and intermittent stimulation group. Conclusions The present results suggest that 2.5Hz continuous and intermittent intraurethral stimulation can inhibit micturition reflex, decrease MVP and increase bladder capacity. There was no significant difference in MVP and bladder capacity between continuous and intermittent stimulation group.
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Affiliation(s)
- Tian Yu
- Department translational neurosciences, Laboratory Urology, University of Antwerp, Faculty GGW, Belgium.,Department of Urology, University Hopsital Antwerp, Antwerp, Belgium.,Department of Urology, China Rehabilitation Research Center, Capital Medical University, Beijing, China.,Department of Urology, Capital Medical University, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, Capital Medical University, Beijing, China.,Department of Urology, Capital Medical University, Beijing, China
| | - Jean Jacques Wyndaele
- Department translational neurosciences, Laboratory Urology, University of Antwerp, Faculty GGW, Belgium.,Department of Urology, University Hopsital Antwerp, Antwerp, Belgium
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Janssen DA, Martens FM, de Wall LL, van Breda HM, Heesakkers JP. Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:109-122. [PMID: 28615976 PMCID: PMC5460621 DOI: 10.2147/mder.s115678] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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.
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Affiliation(s)
- Dick Aw Janssen
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
| | - Frank Mj Martens
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
| | - Liesbeth L de Wall
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen
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Chu CM, Ghetti C. Procedure-Based Management of Urgency Urinary Incontinence in the Older Woman. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0205-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jairam R, Drossaerts J, van Koeveringe G, van Kerrebroeck P. The Impact of Duration of Complaints on Successful Outcome of Sacral Neuromodulation. Urol Int 2017; 99:51-55. [PMID: 28478446 DOI: 10.1159/000456079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The study aimed to evaluate whether the duration of complaints in patients with overactive bladder syndrome or non-obstructive urinary retention predicts the outcome of sacral neuromodulation (SNM). METHODS All patients that underwent a SNM test period evaluation between 2011 and 2014, were included in this study. The duration of complaints was listed in 3 categories: (a) 0-5 years, (b) 5-10 years and (c) 10 years or longer. Analyses with chi square tests were performed to evaluate whether the duration of complaints are associated with outcome of SNM. RESULTS In total, 130 patients were included. Most patients had a complaint duration of 0-5 years (n = 60). The test period was successful in 56% (n = 74) of the total group. Analyses showed that the duration of complaints is not significantly associated with outcome of SNM (p = 0.752), even when subdivided per indication, and also when possible confounders such as age at test and indication are taken into account (p = 0.720). CONCLUSION Based on the results of this study, there is no relationship between duration of complaints and SNM outcome. SNM seems to remain a feasible treatment option, despite of possible anatomical or physiological changes within the lower urinary tract.
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Affiliation(s)
- Ranjana Jairam
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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Ansó M, Veiga-Gil L, De Carlos J, Hualde A, Pérez-Cajaraville J. Neuraxial analgesia in a pregnant woman with Fowler’s syndrome and sacral neuromodulation. Int J Obstet Anesth 2017; 30:58-61. [DOI: 10.1016/j.ijoa.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/15/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
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Palmer CJ, Choi JM. Pathophysiology of Overactive Bladder: Current Understanding. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0402-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Mehmood S, Altaweel WM. Long-term outcome of sacral neuromodulation in patients with idiopathic nonobstructive urinary retention: Single-center experience. Urol Ann 2017; 9:244-248. [PMID: 28794590 PMCID: PMC5532891 DOI: 10.4103/ua.ua_165_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the safety and efficacy of sacral neuromodulation (SNM) in patients with idiopathic nonobstructive urinary retention. MATERIALS AND METHODS We retrospectively reviewed the files of patients who underwent staged neuromodulation for idiopathic nonobstructive urinary retention from 2004 to 2016 at our hospital. Patients who had a 50% improvement in symptoms after 1 week of stage 1 procedure were qualified for permanent device implantation. Patient data were assessed on efficacy and need for intermittent self-catheterization, complications, and operative revision rates. RESULTS Twenty-seven female patients who underwent SNM therapy were analyzed. The mean age of the patients was 32.5 ± 10.8 years. The mean duration of urinary retention was 3.2 ± 1.7 years. All patients were doing intermittent self-catheterization, but few were able to void <100 ml. Twenty-four (88.8%) of the 27 patients demonstrated a >50% improvement in symptoms and underwent permanent device placement. At a median follow-up of 5.7 ± 3.2 years, 20 (83.3%) of the 24 patients demonstrated sustained improvement rates of >50%. Seventeen (70.83%) of 24 patients could void spontaneously with a mean residual urine of 28.1 ± 24.4 ml (P < 0.001). Three (12.5%) were voiding with significant mean decreasing number of catheterizations from 5.6 ± 2.4 to 1.4 ± 2.1 (P < 0.001). Four (16.6%) had their device explanted. Ten (41.6%) of the 24 patients underwent surgical revision. Most of the adverse events were managed by device reprograming. CONCLUSION SNM is a highly effective and safe procedure in this subset of the female population with idiopathic refractory nonobstructive urinary retention.
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Affiliation(s)
- Shahbaz Mehmood
- King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Mohammad Altaweel
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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Sukhu T, Kennelly MJ, Kurpad R. Sacral neuromodulation in overactive bladder: a review and current perspectives. Res Rep Urol 2016; 8:193-199. [PMID: 27822462 PMCID: PMC5087764 DOI: 10.2147/rru.s89544] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Overactive bladder (OAB) symptoms of urgency, frequency, and urge incontinence currently affect a substantial portion of the population, especially as age increases. Sacral neuromodulation has become a popular option for refractory OAB symptoms over the past 2 decades. Studies have demonstrated that it is an effective treatment for OAB and urge incontinence as indicated by decreased number of voids, increased bladder capacity, and fewer leakage events. In addition, the effects have proved to be durable to multiple years following implantation. These benefits come at the expense of a high rate of adverse events, although with comparable long-term cost-effectiveness to botulinum toxin A. We aimed to review the literature that demonstrates that sacral neuromodulation continues to be an efficacious treatment for refractory OAB wet and dry patients, with continuously expanding indications.
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Affiliation(s)
- Troy Sukhu
- Department of Urology, University of North Carolina, Chapel Hill
| | | | - Raj Kurpad
- Department of Urology, University of North Carolina, Chapel Hill
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Bartley JM, Killinger KA, Boura JA, Gupta P, Gaines N, Gilleran JP, Peters KM. The impact of prior back surgery on neuromodulation outcomes: A review of over 500 patients. Neurourol Urodyn 2016; 36:1535-1542. [PMID: 27676460 DOI: 10.1002/nau.23140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/31/2016] [Indexed: 11/10/2022]
Abstract
AIMS To evaluate neuromodulation outcomes in patients with prior back surgery. METHODS Adults in our prospective observational sacral/pudendal neuromodulation study were retrospectively evaluated. History and operative details were reviewed, and outcomes were measured at 3, 6, 12, and 24 months with overactive bladder questionnaire (OAB q) symptom severity (SS)/health related quality of life (HRQOL), interstitial cystitis symptom/problem indices (ICSI - PI), voiding diaries, and global response assessments (GRA). Data were examined with Pearson's χ2 , Fisher's exact, Wilcoxon rank sum tests, and logistic regression multivariate analysis. RESULTS Five hundred and sixty patients were evaluated (mean age 58.8 ± 17 years; 83% female; 79% had a sacral lead placed), 109 (19%) had history of back surgery; 66 surgeries were lumbar. Back surgery patients were older (mean 63 ± 15 vs. 58 ± 17 years; P = 0.003) and a higher proportion had urge urinary incontinence (UUI) (64% vs. 50% P = 0.008). Generator implant rates were similar (94% vs. 91%; P = 0.34). OABq-SS and HRQOL and ICSI - PI composite scores did not differ between groups at any time point. On bladder diaries, median incontinence episodes daily at baseline and between stages were worse in the prior back surgery group but all bladder diary parameters improved significantly in both groups with the exception of mean voided volume which only improved significantly in the non-back surgery group. Most patients in both groups reported moderate/marked improvement in overall bladder symptoms. CONCLUSIONS This study suggests that prior back surgery does not appear to impact clinical outcomes; therefore, neuromodulation may be offered in this patient population.
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Affiliation(s)
- Jamie M Bartley
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | - Judith A Boura
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | | | - Jason P Gilleran
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Kenneth M Peters
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Liberman D, Ehlert MJ, Siegel SW. Optimizing Outcomes of Sacral Neuromodulation for the Treatment of Urinary Retention. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0373-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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