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Leal LCFL, Borges LHB, De Paula MEFDC, Lisboa LL, Dantas AFODA. Development and Validation of an IoT Neurostimulator for the Treatment of Neurogenic Bladder. SENSORS (BASEL, SWITZERLAND) 2023; 23:9284. [PMID: 38005670 PMCID: PMC10674258 DOI: 10.3390/s23229284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023]
Abstract
Neurogenic bladder is a dysfunction in the lower urinary tract due to damage to the nervous system. One of the treatments that has shown important results is transcutaneous neuromodulation. The neuromodulation equipment available on the market does not allow remote activation or offer many resources for adjusting the parameters of the generated stimulus, as most devices operate with pre-established parameters in closed packages. For this reason, customizing therapy for each individual can be difficult. Therefore, the objective was to develop and validate a neuromodulation device capable of being remotely programmed and properly monitored. Materials and methods for validating devices were used according to the Brazilian Regulatory Standard (NBR), which deals with general requirements for the basic safety and essential performance of electromedical devices. After verifying the reliability of the device, which was capable of generating a biphasic and symmetrical wave, measured by an oscilloscope, considered safe by the technical requirements, it was tested in a real application. Users reported feeling a comfortable stimulus, similar to other previously used devices, and considered the device easy to use. In this way, it was possible to demonstrate the reliability and validity of the developed device.
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Affiliation(s)
- Luana Cecilia Farache Lemos Leal
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Macaíba 59280-000, RN, Brazil; (L.H.B.B.); (L.L.L.); (A.F.O.d.A.D.)
| | - Luiz Henrique Bertucci Borges
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Macaíba 59280-000, RN, Brazil; (L.H.B.B.); (L.L.L.); (A.F.O.d.A.D.)
| | | | - Lilian Lira Lisboa
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Macaíba 59280-000, RN, Brazil; (L.H.B.B.); (L.L.L.); (A.F.O.d.A.D.)
| | - André Felipe Oliveira de Azevedo Dantas
- Graduate Program in Neuroengineering, Edmond and Lily Safra International Institute of Neuroscience, Macaíba 59280-000, RN, Brazil; (L.H.B.B.); (L.L.L.); (A.F.O.d.A.D.)
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Rhee JK, Iwamoto Y, Baker BJ. Visualizing Oscillations in Brain Slices With Genetically Encoded Voltage Indicators. Front Neuroanat 2021; 15:741711. [PMID: 34795565 PMCID: PMC8592998 DOI: 10.3389/fnana.2021.741711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
Genetically encoded voltage indicators (GEVIs) expressed pan-neuronally were able to optically resolve bicuculline induced spontaneous oscillations in brain slices of the mouse motor cortex. Three GEVIs were used that differ in their timing of response to voltage transients as well as in their voltage ranges. The duration, number of cycles, and frequency of the recorded oscillations reflected the characteristics of each GEVI used. Multiple oscillations imaged in the same slice never originated at the same location, indicating the lack of a “hot spot” for induction of the voltage changes. Comparison of pan-neuronal, Ca2+/calmodulin-dependent protein kinase II α restricted, and parvalbumin restricted GEVI expression revealed distinct profiles for the excitatory and inhibitory cells in the spontaneous oscillations of the motor cortex. Resolving voltage fluctuations across space, time, and cell types with GEVIs represent a powerful approach to dissecting neuronal circuit activity.
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Affiliation(s)
- Jun Kyu Rhee
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology (UST), Seoul, South Korea.,Brain Science Creative Research Center, Brain Science Institute, Korea Institute of Science and Technology, Seoul, South Korea
| | | | - Bradley J Baker
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology (UST), Seoul, South Korea.,Brain Science Creative Research Center, Brain Science Institute, Korea Institute of Science and Technology, Seoul, South Korea
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Alghafees MA, Alageel MK, Alqahtani MA, Alghazwani Y. Unsuccessful Progression of Sacral Neuromodulation From the Evaluation to the Implantation Stage: A Single-Center Experience. Cureus 2021; 13:e16912. [PMID: 34513485 PMCID: PMC8412884 DOI: 10.7759/cureus.16912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Over the years, sacral neuromodulation (SNM) has become an established and effective treatment for chronic urinary system retention and incontinence. The process of SNM is performed in two stages, the first is an evaluation phase and the second an implant phase. This study aimed to assess the rate of failure of progression from the evaluation to the implantation stage and the factors predicting the outcome of this commonplace procedure. Materials and methods This retrospective cross-sectional study took place at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. All the patients who underwent SNM implantation from January 1, 2016 to January 1, 2021 were included. Patients younger than 14 years and patients who had the SNM implantation in a different hospital and were only followed-up at KAMC were excluded. Patient-related information were extracted from the BESTCare system. Frequency and percentage were used for the categorical variables, and the mean, median, and standard deviation to display the continuous variables. Chi-square test and Mann-Whitney U test were used to test for the association of the categorical variables. Results Among 28 patients, 46.4% (n=13) failed to progress from the evaluation phase to the implantation phase. Gender, age, having a co-morbidity, and SNM indication were not significant factors for predicting the outcome of the SNM evaluation phase. Conclusion The observed failure rate was marginally higher than the ones detected in other studies. Although no significant association was detected between evaluation stage failure and the assigned predictors, the results need to be interpreted with caution due to the small population size. Larger multicenter studies need to be done in order to investigate the link between patient characteristics and the efficacy of SNM. Establishing a concrete evidence would further refine the targeted patient population and indications for SNM.
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Affiliation(s)
- Mohammad A Alghafees
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammed K Alageel
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Meshari A Alqahtani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Feldkamp A, Amasyalı AS, Groegler J, Jellison F, Staack A. Evaluation of progression from first to second stage sacral neuromodulation and unplanned device removal. Turk J Urol 2021; 47:58-65. [PMID: 33112732 PMCID: PMC7815242 DOI: 10.5152/tud.2020.20288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Sacral neuromodulation (SNM) is an advanced treatment option for patients with refractory overactive bladder (OAB) symptoms, urinary retention, and bowel disorders; it is usually performed in 2 separate procedures. This study aims to determine a cohort's progression rate from stage 1 to 2 and predict factors for progression and unplanned device removal or revision. MATERIAL AND METHODS A retrospective review was conducted in patients who underwent SNM at a single institution between June 2012 and May 2019. Progression rates from stage 1 to 2, patient characteristics, and indications for unplanned SNM removal or revision were recorded. Chi-square, Mann-Whitney U, and Fisher's exact tests were used for data analysis. RESULTS A total of 128 patients underwent SNM for 1 or more of the following diagnoses: OAB (n=103), urinary retention (n=15), neurogenic bladder dysfunction (n=4), fecal incontinence (n=2), and constipation (n=4). The progression rate to stage 2 was 92.2% (118/128). Patients who failed to progress to stage 2 had additional diagnoses other than OAB, such as urinary retention or bowel disorders (p=0.007). Fifteen patients (12.7%) required SNM removal or revision within 4 years of surgery. Among these patients, the body mass index was significantly lower (p=0.036). CONCLUSION Most patients (92.2%) progressed to stage 2. Patients with only OAB symptoms had a higher progression rate to stage 2. Single full-stage procedures may be considered in select patients to reduce morbidity, time, and costs.
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Affiliation(s)
- Ashley Feldkamp
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Akın S Amasyalı
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Jason Groegler
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Forrest Jellison
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Andrea Staack
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
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Afferi L, Pannek J, Louis Burnett A, Razaname C, Tzanoulinou S, Bobela W, da Silva RAF, Sturny M, Stergiopulos N, Cornelius J, Moschini M, Iselin C, Salonia A, Mattei A, Mordasini L. Performance and safety of treatment options for erectile dysfunction in patients with spinal cord injury: A review of the literature. Andrology 2020; 8:1660-1673. [PMID: 32741129 DOI: 10.1111/andr.12878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND For a large proportion of patients with spinal cord injury, sexuality and reproduction are important issues. However, sparse data exist regarding available treatment options for this patient population. OBJECTIVES We sought to review performance and safety rates of all currently available treatment options for erectile dysfunction in spinal cord injury men. MATERIALS AND METHODS A systematic literature review without time restrictions was performed using PubMed/EMBASE database for English-, Italian-, German-, and Spanish-language articles. Articles' selection was performed according to the PRISMA guidelines. Relevant papers on erectile dysfunction in spinal cord injury patients were included in the final analyses. RESULTS AND DISCUSSION Overall, 47 studies were eligible for inclusion in this review. Of these, most evidence dealt with phosphodiesterase 5-inhibitors and intracavernous drug injection. Both treatment options are associated with high levels of performance and with patients/partners' satisfaction; side effects are acceptable. Overall, penile prostheses and vacuum erection devices are in general less approved by spinal cord injury patients and are correlated with increased rates of complications in comparison with phosphodiesterase 5-inhibitors and intracavernous drug injection. Sacral neuromodulation, transcutaneous electrical nerve stimulation, and intraurethral suppositories have been poorly studied, but preliminary studies did not show convincing results. CONCLUSION The best treatment options for erectile dysfunction in spinal cord injury patients emerged to be phosphodiesterase 5-inhibitors and intracavernous drug injection. The choice of erectile dysfunction treatment should be based on several aspects, including residual erectile function, spinal cord injury location, and patients' comorbidities. Future studies assessing the applicability of less well-studied treatments, as well as evaluating innovative options, are needed in this specific population.
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Affiliation(s)
- Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Schweizer Paraplegiker Zentrum, Nottwil, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arthur Louis Burnett
- Department of Urology, John Hopkins Hospital, Brady Urological Institute, Baltimore, MA, USA
| | | | | | | | | | - Mikael Sturny
- Comphya SA, EPFL Innovation Park, Lausanne, Switzerland
| | | | - Julian Cornelius
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christophe Iselin
- Division of Urology, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
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Malde S, Marcelissen T, Vrijens D, Apostilidis A, Rahnama'I S, Cardozo L, Lovick T. Sacral nerve stimulation for refractory OAB and idiopathic urinary retention: Can phenotyping improve the outcome for patients: ICI-RS 2019? Neurourol Urodyn 2020; 39 Suppl 3:S96-S103. [PMID: 32662561 DOI: 10.1002/nau.24204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 11/09/2022]
Abstract
AIMS Sacral nerve stimulation (SNS) is widely used to treat refractory idiopathic overactive bladder (OAB) and idiopathic urinary retention. However, clinical outcomes are variable and understanding predictive factors for success or side-effects would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence-Research Society meeting 2019, a Think Tank was convened to discuss how advances in the basic science study of SNS may be translatable into clinical practice to improve outcomes of patients undergoing SNS treatment. METHODS We conducted a literature review and expert consensus meeting focusing on current methods of phenotyping patients and specifically, how advances in basic science research of the mechanism of action of SNS can be translated into clinical practice to improve patient selection for therapy. RESULTS The terms "Idiopathic OAB" and "idiopathic urinary retention" encompass several underlying pathophysiological phenotypes. Commonly, phenotyping is based on clinical and urodynamic factors. Animal studies have demonstrated that high-frequency stimulation can produce rapid onset, reversible conduction block in peripheral nerves. Altering stimulation parameters may potentially enable personalization of therapy depending upon the clinical indication in the future. Similarly, advances in conditional and closed-loop stimulation may offer greater efficacy for certain patients. Phenotyping based on psychological comorbidity requires further study to potentially optimize patient selection for therapy. CONCLUSIONS Idiopathic OAB and idiopathic urinary retention are heterogenous conditions with multiple potential underlying phenotypes. Tailoring stimulation parameters to the needs of each individual according to phenotype could optimize outcomes. Assessing psychological comorbidity may improve patient selection. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sajjad Rahnama'I
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Thelma Lovick
- School of Physiology, Pharmacology, and Neuroscience, University of Bristol, Bristol, UK
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Neuromodulation - a therapeutic option for refractory overactive bladder. A recent literature review. Wideochir Inne Tech Maloinwazyjne 2019; 14:476-485. [PMID: 31908692 PMCID: PMC6939208 DOI: 10.5114/wiitm.2019.85352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/09/2019] [Indexed: 11/17/2022] Open
Abstract
Overactive bladder (OAB) affects approximately 17% of the population. The treatment of this clinical condition is challenging, especially when conservative therapy is not effective. There are limited options for the treatment of recurrent OAB. Neuromodulation has taken a significant place in the therapy of recalcitrant lower urinary tract dysfunctions over the past 20 years. The aim of this study was to review the literature evaluating the different forms of neuromodulation in various urological clinical conditions and to show the future prospects of this treatment method. Further studies are necessary to determine the effectiveness of neuromodulation and to identify the prognostic factors of therapeutic success. This could be helpful in the selection of patients who will be most likely to respond positively to the treatment.
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Malde S, Fry C, Schurch B, Marcelissen T, Averbeck M, Digesu A, Sahai A. What is the exact working mechanism of botulinum toxin A and sacral nerve stimulation in the treatment of overactive bladder/detrusor overactivity? ICI-RS 2017. Neurourol Urodyn 2018; 37:S108-S116. [DOI: 10.1002/nau.23552] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/19/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sachin Malde
- Department of Urology; Guy's Hospital; London United Kingdom
| | - Christopher Fry
- School of Physiology, Pharmacology & Neuroscience; University of Bristol; Bristol United Kingdom
| | - Brigitte Schurch
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service Vaudois University Hospital of Lausanne; Switzerland
| | - Tom Marcelissen
- Department of Urology; Maastricht University Medical Centre; Netherlands
| | | | - Alex Digesu
- Department of Urogynaecology; St. Mary's Hospital; United Kingdom
| | - Arun Sahai
- Department of Urology; Guy's Hospital; London United Kingdom
- King's College London; King's Health Partners; United Kingdom
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Pea U, Zago T, Areta L, Marzorati G. Vesico-sphincter dysfunctions in Pure Cerebellar Syndrome (PCS): a possible basis for the study of anatomo-functional correlations. Urologia 2018. [DOI: 10.1177/039156030807500107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The neurological polymorphism of Pure Cerebellar Syndromes (not including the heredodegenerative patterns) led the Authors to try to verify the possible correlations between neurological damages and urodynamic findings. Material and Methods. From 2001 to 2006 thirty patients affected by PCS were studied. They underwent several neurological and urological investigations, including videourodynamics. Results. Sixteen cases (76%) showed urinary incontinence due to non-inhibited detrusor contractions, with no evidence of vesico-sphincter dyssynergia; the remaining patients showed a moderate degree of incoordination. Conclusions. The authors highlight the basic role of cerebellum in modulating the motor activities and the coordination of the bladder-sphincter structures, also in the light of the outcomes gathered in these patients, who were not suffering from other superior structure deficiencies.
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Affiliation(s)
- U. Pea
- SC Urologia, AO Fatebenefratelli-Oftalmico
| | - T. Zago
- SC Urologia, AO Fatebenefratelli-Oftalmico
| | - L. Areta
- SC Urologia, AO Niguarda, Milano
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10
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Averbeck MA, Gomes CM. Worldwide Utilization Patterns of Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0383-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Neuromodulation for Pelvic Pain and Sexual Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sacral neuromodulation and female sexuality. Int Urogynecol J 2015; 26:1751-7. [PMID: 25876714 DOI: 10.1007/s00192-015-2708-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An up-to-date review of the impact of a permanent sacral neuromodulation (SNM) implant (Medtronic, Minneapolis, Minnesota, USA) on female sexual function (FSF). METHODS Clinical studies published from January 2001 to February 2014 evaluating the impact and/or safety of permanent SNM on FSF were reviewed. RESULTS Nine studies were selected that investigated the impact on sexual response when the aim of the SNM was to resolve urinary symptoms mainly due to overactive bladder (seven studies) or faecal incontinence. Most women included were of menopausal age. Three studies included sexually inactive women. Post-SNM follow-up varied from 3 to 36 months. Meta-analysis of efficacy results was not possible primarily due to the heterogeneity of the sexual and pelvic dysfunctions. The most specific questionnaire assessing FSF was the Female Sexual Function Index (FSFI) used in six studies. During follow-up all women showed statistically significant improvement (p < 0.05) in at least one FSFI domain compared to baseline. In one study statistically significant improvement (p < 0.05) in the FSFI pain domain was exclusively detected in women with neurological disease. Two studies, however, using the questionnaire to screen for sexual dysfunction did not find any statistically significant differences after SNM. The most severe problems associated with FSF concern loss of libido and reduction in vaginal lubrication which were resolved in one woman following removal of the SNM implant. CONCLUSIONS Actual data are still insufficient to definitely assert the positive effect of SNM on FSF.
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Estado actual de la neuromodulación sacra. UROLOGÍA COLOMBIANA 2015. [DOI: 10.1016/j.uroco.2015.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Banakhar M, Gazwani Y, Kelini ME, Al-Shaiji T, Hassouna M. Effect of sacral neuromodulation on female sexual function and quality of life: Are they correlated? Can Urol Assoc J 2014; 8:E762-7. [PMID: 25485001 DOI: 10.5489/cuaj.2300] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTON Sacral neuromodulation (SNM) has become an established therapy for voiding dysfunction. Additional benefits, such as improved bowel functions and bladder pain, have been reported. Improvement in female sexual function after SNM treatment has been suggested; however, reports examining the effects of SNM on female sexual functions are scarce. We evaluate the effects of SNM on female sexual function and its impact on quality of life and analyze any correlation. METHODS Data were collected from January 2010 to May 2012 for all female patients who underwent SNM InterStim (Medtronic, Minneapolis, MN) therapy at a single centre in Canada. They were treated for voiding dysfunction, including refractory over-active bladder, frequency-urgency syndrome and non-obstructive urinary retention. Patients were screened by percutaneous nerve evaluation (PNE) to assess their response to therapy using a 4-day voiding diary. Patients who experienced 50% or more improvement in their voiding parameters were permanently implanted. All patients completed the Female Sexual Function Index (FSFI), Short-Form Health Survey (SF-36), and incontinence questionnaires (Urinary Distress Inventory [UDI]-6) preoperatively and 4 months postoperatively. RESULTS A total of 33 female patients had SNM therapy; 10 were excluded from the study because they were not sexually active. The indications were: refractory overactive bladder in 19, frequency-urgency syndrome in 2, and non-obstructive urinary retention in another 2 patients. SNM therapy significantly improved the total FSFI score (p = 0.011); the components of desire and orgasm showed significant improvement (p = 0.014 and p = 0.035, respectively). Age, body mass index, diagnosis, and urinary symptoms did not show significant correlation with FSFI score improvement. Quality of life showed significant improvement after SNM treatment in 5 categories. There was no correlation between improvement in quality of life and FSFI. CONCLUSION SNM may improve female sexual function and quality of life, yet there is no correlation between the improvement in FSFI and quality of life.
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Affiliation(s)
- Mai Banakhar
- Department of Urology, King Abdulaziz University, Faculty of Medicine, Jeddah, Kingdom of Saudi Arabia
| | - Yahya Gazwani
- Department of Urology, King Abdulaziz University, Faculty of Medicine, Jeddah, Kingdom of Saudi Arabia
| | - Mohamed El Kelini
- Department of Urology, King Abdulaziz University, Faculty of Medicine, Jeddah, Kingdom of Saudi Arabia
| | - Tariq Al-Shaiji
- Department of Urology, University of Toronto, Toronto Western Hospital, Toronto, ON
| | - Magdy Hassouna
- Department of Urology, University of Toronto, Toronto Western Hospital, Toronto, ON
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15
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Percutaneous tibial nerve stimulation as an off-label treatment of clitoral pain. Female Pelvic Med Reconstr Surg 2014; 20:e1-4. [PMID: 25185622 DOI: 10.1097/spv.0000000000000086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Percutaneous tibial nerve stimulation (PTNS) is used to treat refractory urinary frequency, urgency, and urgency urinary incontinence. To date, it is not approved by the US Food and Drug Administration in the treatment of chronic pain syndromes, and its use in the treatment of chronic clitoral pain has not been reported. METHODS We describe 2 cases of women who presented with symptoms of urgency urinary incontinence, urinary frequency, and clitoral pain. After inadequate response to conservative treatment of their urinary symptoms, they received PTNS. RESULTS By the 12th session, significant improvement in urinary symptoms and resolution of clitoral pain were noted. CONCLUSIONS The findings of this report suggest that PTNS may be a therapeutic option in patients with idiopathic clitoral pain.
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Okun MS, Oyama G. [Mechanism of action for deep brain stimulation and electrical neuro-network modulation (ENM)]. Rinsho Shinkeigaku 2014; 53:691-4. [PMID: 24097315 DOI: 10.5692/clinicalneurol.53.691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Deep brain stimulation (DBS) has become an important treatment option for carefully screened medication resistant neurological and neuropsychiatric disorders. DBS therapy is not always applied deep to the brain; does not have to be applied exclusively to the brain; and the mechanism for DBS is not simply stimulation of structures. The applications and target locations for DBS devices are rapidly expanding, with many new regions of the brain, spinal cord, peripheral nerves, and muscles now possibly accessed through this technology. We will review the idea of "electrical neuro-network modulation (ENM)"; discuss the importance of the complex neural networks underpinning the effects of DBS; discuss the expansion of brain targets; discuss the use of fiber based targets; and discuss the importance of tailoring DBS therapy to the symptom, rather than the disease.
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Affiliation(s)
- Michael S Okun
- Center for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida
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Tirlapur SA, Vlismas A, Ball E, Khan KS. Nerve stimulation for chronic pelvic pain and bladder pain syndrome: a systematic review. Acta Obstet Gynecol Scand 2013; 92:881-7. [PMID: 23710833 DOI: 10.1111/aogs.12184] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/19/2013] [Indexed: 01/14/2023]
Abstract
Chronic pelvic pain (CPP) and bladder pain syndrome (BPS) can have a negative impact on quality of life. Neuromodulation has been suggested as a possible treatment for refractory pain. To assess the effectiveness of tibial and sacral nerve stimulation in the treatment of BPS and CPP. We searched until July 2012: the Cochrane Library, EMBASE (1980-2012), Medline (1950-2012), Web of knowledge (1900-2012), LILACS (1982-2012) and SIGLE (1990-2012) with no language restrictions. We manually searched through bibliographies and conference proceedings of the International Continence Society. Randomized and prospective quasi-randomized controlled studies vs. sham nerve stimulation treatment or usual care of patients with CPP and BPS who underwent sacral or tibial nerve stimulation were included. Any studies involving transcutaneous stimulation were excluded. The outcome was a cure or improvement in symptoms. Three studies with 169 patients treated with tibial nerve stimulation were included; two for CPP and one for BPS. There were improvements in pain, urinary and quality of life scores. There were no reported data for sacral nerve stimulation. There is scanty literature reporting variable success of posterior tibial nerve stimulation in improving pain, urinary symptoms and quality of life in CPP and BPS. In view of the dearth of quality literature, a large multi-centered clinical trial investigating the effectiveness of electrical nerve stimulation to treat BPS and CPP along with the cost-analysis of this treatment is recommended.
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Affiliation(s)
- Seema A Tirlapur
- Women's Health Research Unit, Queen Mary, University of London, London, UK.
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Biemans JMAE, van Balken MR. Efficacy and effectiveness of percutaneous tibial nerve stimulation in the treatment of pelvic organ disorders: a systematic review. Neuromodulation 2012; 16:25-33; discussion 33. [PMID: 22985128 DOI: 10.1111/j.1525-1403.2012.00504.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This systematic review aimed to determine the efficacy and effectiveness of percutaneous tibial nerve stimulation (PTNS) on symptoms of overactive bladder (OAB) and pelvic organ disorders, pain, adverse events (AEs), and quality of life (QoL). METHODS A literature search was performed in September 2011 in the databases MEDLINE, CINAHL, and EMBASE. Hand searching of references was conducted. Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) with adult patients were included. RESULTS Seven studies met the eligibility criteria. Five RCTs indicated improvement (range 36.7-80%) on OAB symptoms, frequency, urgency, nocturia, and incontinence. One CCT reported improvement (mean 15.7) in 53% of the subjects on fecal incontinence (FI) symptoms on an FI Questionnaire (range 0-20). One RCT showed more than 50% improvement on pain (40%) and symptom scores (66.6%) in chronic pelvic pain (CPP). Limitations are the small amount, overall low quality, and variety in outcome measures of included studies. Only minor AEs were reported. No meta-analysis was performed as a consequence of heterogeneous data. CONCLUSIONS This systematic review provides evidence for the efficacy of PTNS on symptoms, pain, and QoL measures of OAB, FI and category IIIB CP/CPP. Evidence of effectiveness was found on symptoms and QoL for OAB. The total amount of seven included studies, from which even the most favorable study has some potential bias, is too small to draw firm conclusions. Independent high quality RCTs are necessary to confirm and delineate the range of therapeutic effects of PTNS in this region. PTNS is a safe intervention.
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Improvement of bowel dysfunction with sacral neuromodulation for refractory urge urinary incontinence. Int Urogynecol J 2011; 23:735-41. [DOI: 10.1007/s00192-011-1553-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
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The Puzzle of Pelvic Pain—A Rehabilitation Framework for Balancing Tissue Dysfunction and Central Sensitization, I. ACTA ACUST UNITED AC 2011. [DOI: 10.1097/jwh.0b013e31823b0750] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Gill BC, Swartz MA, Firoozi F, Rackley RR, Moore CK, Goldman HB, Vasavada SP. Improved sexual and urinary function in women with sacral nerve stimulation. Neuromodulation 2011; 14:436-43; discussion 443. [PMID: 21854492 DOI: 10.1111/j.1525-1403.2011.00380.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Urinary and sexual function improve following sacral nerve stimulation (SNS) for refractory overactive bladder. No significant associations between these changes have been found. Whether improvements in sexual function are independent of or secondary to improvements in urinary function remains unclear. The aim of this study was to analyze changes in urinary and sexual function in a homogeneous sample of patients undergoing SNS for urge urinary incontinence and subsequently identify associations between the two. MATERIALS AND METHODS A prospective database was created. Enrollees underwent a full history and physical examination at the first office visit. Multiple-day voiding diaries with validated and investigator-designed questionnaires were administered at baseline and follow-up as standard implantation procedures and to assess changes in urinary and sexual function, respectively. Analyses were completed using data from patients who were sexually active at baseline and follow-up. RESULTS Statistically significant improvements in urinary and sexual function occurred according to multiple metrics. Patient global impression scales categorized all patients' urinary conditions as improved, with most being less severe. Validated urinary symptom and quality of life scores improved significantly. After treatment, most patients were incontinent less often with sexual activity and felt less restricted from sexual activity by fear of incontinence. Validated quantification of sexual function demonstrated significant improvements in overall sexual function, arousal, and satisfaction. No significant associations between changes in urinary and sexual function were noted; however, trends appeared to exist between the two. CONCLUSIONS Improved sexual function was not significantly associated with improved urinary function after SNS despite apparent trends between the two. Larger samples are required to definitively demonstrate this conclusion.
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Affiliation(s)
- Bradley C Gill
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Alsaid B, Moszkowicz D, Peschaud F, Bessede T, Zaitouna M, Karam I, Droupy S, Benoit G. Autonomic-somatic communications in the human pelvis: computer-assisted anatomic dissection in male and female fetuses. J Anat 2011; 219:565-73. [PMID: 21781094 DOI: 10.1111/j.1469-7580.2011.01416.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Sphincter continence and sexual function require co-ordinated activity of autonomic and somatic neural pathways, which communicate at several levels in the human pelvis. However, classical dissection approaches are only of limited value for the determination and examination of thin nerve fibres belonging to autonomic supralevator and somatic infralevator pathways. In this study, we aimed to identify the location and nature of communications between these two pathways by combining specific neuronal immunohistochemical staining and three-dimensional reconstruction imaging. We studied 14 normal human fetal pelvic specimens (seven male and seven female, 15-31 weeks' gestation) by three-dimensional computer-assisted anatomic dissection (CAAD) with neural, nitrergic and myelin sheath markers. We determined the precise location and distribution of both the supra- and infralevator neural pathways, for which we provide a three-dimensional presentation. We found that the two pathways crossed each other distally in an X-shaped area in two spatial planes. They yielded dual innervation to five targets: the anal sphincter, levator ani muscles, urethral sphincter, corpus spongiosum and perineal muscles, and corpora cavernosa. The two pathways communicated at three levels: proximal supralevator, intermediary intralevator and distal infralevator. The dorsal penis/clitoris nerve (DN) had segmental nitrergic activity. The proximal DN was nNOS-negative, whereas the distal DN was nNOS-positive. Distal communication was found to involve interaction of the autonomic nitrergic cavernous nerves with somatic nitrergic branches of the DN, with nitrergic activity carried in the distal part of the nerve. In conclusion, the pelvic structures responsible for sphincter continence and sexual function receive dual innervation from the autonomic supralevator and the somatic infralevator pathways. These two pathways displayed proximal, intermediate and distal communication. The distal communication between the CN and branches of the DN extended nitrergic activity to the distal part of the cavernous bodies in fetuses of both sexes. These structures are important for erectile function, and care should therefore be taken to conserve this communication during reconstructive surgery.
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Affiliation(s)
- Bayan Alsaid
- Laboratory of Experimental Surgery, EA 4122, Faculty of Medicine, University of Paris-Sud 11, Le Kremlin-Bicêtre, France.
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Abstract
Objectives: Sacral neuromodulation has gained increased worldwide acceptance as the standard of care in patients with refractory overactive bladder (OAB) and non-obstructive urinary retention (NOUR). This review will detail the evolution of the technology. Materials and Methods: The mechanism of action and advances in treatment, including tined lead, fluoroscopic imaging, and smaller implantable pulse generator (IPG) are reviewed. This discussion also explores expanding indications and future advances including interstitial cystitis, chronic pelvic pain, neurogenic bladder, fecal incontinence, constipation, and dysfunctional elimination syndrome in children. Results: Sacral neuromodulation (SNM) exerts its influence by modulation of sacral afferent inflow on storage and emptying reflexes. The tined lead allows for placement and stimulation to be performed in the outpatient setting under local anesthesia with mild sedation. Lead migration has been minimal and efficacy improved. The use of fluoroscopy has improved accuracy of lead placement and has led to renewed interest in bilateral percutaneous nerve evaluation (PNE). Bilateral PNE can be performed in the office setting under local anesthesia, making a trial of therapy less expensive and more attractive to patients. A smaller IPG has not only improved cosmesis, but decreased local discomfort and need for revision. The role for SNM continues to expand as clinical research identifies other applications for this therapy. Conclusions: Our understanding of SNM, as well as technological advances in therapy delivery, expands the pool of patients for which this form of therapy may prove beneficial. Less invasive instrumentation may even make this form of therapy appealing to patients without refractory symptoms.
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Affiliation(s)
- Jannah H Thompson
- Metropolitan Urology, Cornerstone Medical Specialty, 6025 Lake Road, Suite 100, Woodbury, MN, USA
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Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J 2010; 21:1553-8. [DOI: 10.1007/s00192-010-1281-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Sacral Neuromodulation in Children With Urinary and Fecal Incontinence: A Multicenter, Open Label, Randomized, Crossover Study. J Urol 2010; 184:696-701. [DOI: 10.1016/j.juro.2010.03.054] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Indexed: 11/20/2022]
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Kim JH, Hong JC, Kim MS, Kim SH. Sacral nerve stimulation for treatment of intractable pain associated with cauda equina syndrome. J Korean Neurosurg Soc 2010; 47:473-6. [PMID: 20617098 DOI: 10.3340/jkns.2010.47.6.473] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 12/15/2009] [Accepted: 05/23/2010] [Indexed: 11/27/2022] Open
Abstract
Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.
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Affiliation(s)
- Jong-Hoon Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
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Pannek J, Göcking K, Bersch U. Long-term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction. BJU Int 2009; 104:1246-50. [DOI: 10.1111/j.1464-410x.2009.08600.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Falletto E, Masin A, Lolli P, Villani R, Ganio E, Ripetti V, Infantino A, Stazi A. Is sacral nerve stimulation an effective treatment for chronic idiopathic anal pain? Dis Colon Rectum 2009; 52:456-62. [PMID: 19333046 DOI: 10.1007/dcr.0b013e31819d1319] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic idiopathic anal pain is a common, benign symptom, the etiology of which remains unclear. Traditional treatments are often ineffective. This study investigated the efficacy of sacral nerve stimulation in treating chronic idiopathic anal pain. METHODS Twelve patients (10 women and 2 men; mean age, 61.0 +/- 10.3 years; range, 48-82 years) implanted with a permanent device for sacral nerve stimulation were followed in the Italian Group for Sacral Neuromodulation (GINS) Registry. All patients had frequent chronic anal or perianal pain; 75 percent had previously undergone pelvic surgery. Pharmacologic and rehabilitative therapy had yielded poor results. Changes from baseline to last follow-up examination were evaluated for scores on a visual analog pain scale (0-10) and the Short-Form 36 (SF-36) health status questionnaire. Manometric measurements recorded at last follow-up were compared with preimplantation values. RESULTS In one patient, the permanent device was removed because of technical failure. After a mean follow-up of 15 (range, 3-80) months, visual analog pain scores had significantly improved (from 8.2 +/- 1.7 to 2.2 +/- 1.3, P < 0.001). SF-36 physical component scores increased from 26.27 +/- 5.65 to 38.95 +/- 9.08, P < 0.02). Scores on the mental component showed improvement, although not significant. Postimplantation changes in manometric functional data were not significant, but sensitivity thresholds showed a considerable decrease. CONCLUSIONS Long-term follow-up data showing improvements in scores on the visual analog pain scale and quality of life questionnaire indicate that, before adopting more aggressive surgical procedures, SNS should be considered for patients with chronic idiopathic anal pain in whom pharmacologic and biofeedback treatments have failed to produce effective results.
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Affiliation(s)
- Ezio Falletto
- VI Divisione di Chirurgia Universitaria, Department of General Surgery, San Giovanni Battista Hospital, Turin, Italy.
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Kaufmann S, Naumann CM, Hamann MF, Seif C, Braun PM, Jünemann KP, van der Horst C. Unilateral vs bilateral sacral neuromodulation in pigs with formalin-induced detrusor hyperactivity. BJU Int 2009; 103:260-3. [DOI: 10.1111/j.1464-410x.2008.07936.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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33
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Chun KM, Yoon H. A Short-Term Analysis of Parameters Affecting the Outcome of Sacral Neuromodulation. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kye Min Chun
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hana Yoon
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea
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Lombardi G, Mondaini N, Giubilei G, Macchiarella A, Lecconi F, Del Popolo G. Sacral Neuromodulation for Lower Urinary Tract Dysfunction and Impact on Erectile Function. J Sex Med 2008; 5:2135-40. [DOI: 10.1111/j.1743-6109.2008.00948.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lombardi G, Mondaini N, Macchiarella A, Cilotti A, Popolo GD. Clinical Female Sexual Outcome after Sacral Neuromodulation Implant for Lower Urinary Tract Symptom (LUTS). J Sex Med 2008; 5:1411-7. [DOI: 10.1111/j.1743-6109.2008.00812.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Burks FN, Diokno AC, Lajiness MJ, Ibrahim IA, Peters KM. Sacral neuromodulation reprogramming: is it an office burden? Int Urogynecol J 2008; 19:1137-40. [PMID: 18392551 DOI: 10.1007/s00192-008-0601-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Accepted: 02/27/2008] [Indexed: 10/22/2022]
Abstract
Our objective was to evaluate the burden of sacral neuromodulation (SNM) reprogramming and the reasons for reprogramming, and to correlate these with the underlying diagnosis. A retrospective review of 50 consecutive subjects implanted with SNM was completed from November 2002 through December 2005. Of the 50 SNM implants, 47 subjects had adequate follow-up. The mean age was 53.1 (22-90 years) with 83% women. Of the SNM performed, 91.5% were done for urinary urgency, frequency, or incontinence and 47.4% of those had interstitial cystitis. Overall, 239 programming visits were recorded, and subjects on average had two reprogramming visits per year. There was no correlation with number of reprogramming events and patient age, sex, reason for implantation, or diagnosis. These data suggest that the number of reprogramming episodes is small, and the majority is done as part of routine follow-up. No additional burden was seen in subjects with interstitial cystitis.
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Affiliation(s)
- Frank N Burks
- Department of Urology, William Beaumont Hospital, 3535 W. 13 Mile Road Suite 438, Royal Oak, MI 48073, USA.
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Nakib N, Siegel S. Neuromodulation versus neurotoxin for the treatment of refractory detrusor overactivity: for neuromodulation. ACTA ACUST UNITED AC 2008; 5:118-9. [PMID: 18195723 DOI: 10.1038/ncpuro1033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Accepted: 12/05/2007] [Indexed: 11/09/2022]
Affiliation(s)
- Nissrine Nakib
- Metropolitan Urologic Specialists, Woodbury, MN 55125, USA
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Lee JZ. Electrical Stimulation for Refractory Overactive Bladder. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.3.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeong Zoo Lee
- Department of Urology, Pusan National University College of Medicine, Korea.
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Chartier-Kastler E. Sacral neuromodulation for treating the symptoms of overactive bladder syndrome and non-obstructive urinary retention: >10 years of clinical experience. BJU Int 2007; 101:417-23. [DOI: 10.1111/j.1464-410x.2007.07233.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gignoux A, Le Normand L, Labat JJ, Bouchot O, Rigaud J, Buzelin JM. Etude sur l’efficacité et les complications à moyen terme de 41 implantations de neuromodulateur des racines sacrées (InterstimTM, Medtronic, USA) dans les troubles urinaires réfractaires. Prog Urol 2007; 17:1355-61. [DOI: 10.1016/s1166-7087(07)78577-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Liem O, Benninga MA, Mousa HM, Di Lorenzo C. Novel and alternative therapies for childhood constipation. Curr Gastroenterol Rep 2007; 9:214-8. [PMID: 17511919 DOI: 10.1007/s11894-007-0021-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Constipation is a worldwide problem that affects many children. Treatment of constipation is largely based on clinical experience rather than on evidence-based controlled clinical trials. Stool softeners and cathartic agents in combination with behavioral interventions constitute the programs most commonly used to facilitate painless and frequent defecation. Long-term treatment is needed for most patients, and approximately 30% of children beyond puberty continue to struggle with symptoms of constipation, such as infrequent, painful evacuation of stools and fecal incontinence. Not surprisingly, chronicity of these bowel complaints may cause significant interference with the child's emotional growth and development. Development of new therapeutic strategies is necessary in order to treat these challenging patients more effectively. This review provides an overview of novel and alternative therapies, such as new drugs, surgery, and probiotics, that are being proposed for the treatment of childhood chronic constipation.
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Affiliation(s)
- Olivia Liem
- Department of Pediatric Gastroenterology and Nutrition, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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Sutherland SE, Lavers A, Carlson A, Holtz C, Kesha J, Siegel SW. Sacral nerve stimulation for voiding dysfunction: One institution's 11-year experience. Neurourol Urodyn 2007; 26:19-28; discussion 36. [PMID: 17078071 DOI: 10.1002/nau.20345] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM The purpose of this study was to review our institution's 11-year experience with SNS for the treatment of refractory voiding dysfunction. Dating back to 1993, it covers a span of time which describes the evolution of SNS as it includes PNE trials, non-tined (bone-anchored or fascial-anchored) leads, percutaneous tined leads with two-staged procedures, and even percutaneous pudendal trials. METHODS A retrospective review was performed on SNS patients who received an implantable pulse generator (IPG) in our practice from 12/1993 to 12/2004. After Institutional Review Board approval, consents for chart review were obtained from 104 patients, representing 44% of this neuromodulatory patient population. RESULTS Of our population, 87% were female and 13% were male. Average age at implant was 50 years +/- 13.4 years. Duration of symptoms before implantation was 116 months (range 9-600 months). Eighty percent were implanted for a predominant complaint of urinary urgency and frequency (U/F). Overall, 22% had U/F only, 38% had concomitant urge incontinence (UI), and 20% had concomitant mixed incontinence (MI). Twenty percent were treated for non-obstructive urinary retention (UR), with half of these associated with a neurogenic etiology. Additionally, 46.2% had pelvic pain, 58.6% had bowel complaints, and 51% reported sexual dysfunction. In patients with U/F, mean voiding parameters as described by pre-implant voiding diaries revealed the following: 12.4 (+/-5.1) voids per 24 hr; 2.3 (+/-1.8) voids per night; 5.0 (+/-4.7) leaks per 24 hr; and 2.3 (+/-2.6) pads per 24 hr. Statistically significant improvements post-implantation were noted with mean decreases in the following: 4.3 voids per 24 hr; 1.0 void per night; 4.4 leaks per 24 hr; and 2.3 pads per 24 hr (all P < 0.05). In the UR group a statistically significant improvement post-implantation was noted only in voids per night, with a mean decrease of 0.8 (P < 0.05). With a mean follow up of 22 months (range 3-162 months), sustained subjective improvement was >50%, >80%, and >90% in 69%, 50%, and 35% of patients, respectively. By quality of life survey, 60.5% of patients were satisfied and 16.1% were dissatisfied with current urinary symptoms. Only 13% (14 patients) abandoned therapy, making up a significant portion of those dissatisfied with current urinary symptoms. Good overall lead durability was seen (mean 22 months, range 1-121 months), with the first successful lead proving to be the most durable (mean 28 months, range 1.4-120 months). Lead durability decreased progressively with subsequent trials. Overall, 53% of patients experienced at least one reportable event (RE) attributable to either lead or IPG. A total of 126 REs were noted, with 97% mild-to-moderate in severity. REs included lack of efficacy, loss of efficacy, infection, hematoma/seroma, migration, pain, undesirable change in sensation, and device malfunction. In this population, 47.1% of leads were tined while 52.9% were non-tined. Tined leads had an overall lower RE rate as compared to non-tined leads: 28% and 73%, respectively. CONCLUSIONS SNS is an effective method for treating certain types of voiding dysfunction. Although 53% of patients experienced at least one RE, 97% were mild-to-moderate and did not appear to affect the continued use of this therapy. With improved technology, such as percutaneous tined leads, the RE rate is decreasing. Further analyses of subsets of this population are currently underway.
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Affiliation(s)
- Suzette E Sutherland
- Metro Urology, Center for Continence Care and Female Urology, Minneapolis/St. Paul, Minnesota 55441, USA.
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Chung JW, Han DH, Lee KS. Efficacy and Safety of Sacral Neuromodulation (Interstim®) for the Treatment of Refractory Overactive Bladder Symptoms and Chronic Pelvic Pain. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.7.701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jin Woo Chung
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Hyun Han
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Pharmacotherapy is the first-line treatment for overactive bladder, but many patients discontinue drug therapy because of intolerable side effects, expense, or lack of longterm adherence. Alternative treatments are needed for patients who are unable to tolerate pharmacotherapy or who do not derive the desired benefits. Sacral nerve stimulation therapy has evolved into one of the most widely accepted treatment modalities in the arena of neurourology. Sacral nerve stimulation activates or "resets" the somatic afferent inputs that play a pivotal role in the modulation of sensory processing for micturition reflex pathways in the spinal cord. This minimally invasive technology offers a safe, reliable, and durable treatment for lower urinary tract dysfunction.
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Affiliation(s)
- Wendy W Leng
- Department of Urology, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 700, Pittsburgh, PA 15213, USA.
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Pauls RN, Marinkovic SP, Silva WA, Rooney CM, Kleeman SD, Karram MM. Effects of sacral neuromodulation on female sexual function. Int Urogynecol J 2006; 18:391-5. [PMID: 16868656 DOI: 10.1007/s00192-006-0168-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 06/08/2006] [Indexed: 10/24/2022]
Abstract
The aim of this prospective study was to determine if sacral neuromodulation has an effect on the patient's subsequent sexual function. Sexually active patients that underwent an Interstim Sacroneuromodulator implantation (Medtronic, Minneapolis, MN) for control of bladder symptoms were enrolled. A Female Sexual Function Index (FSFI) was completed before surgery and at a mean of 5.7 months postoperatively. Eleven subjects proceeded to permanent implantation, seven of these were sexually active before and after placement. Three subjects (43%) felt the device impacted on their sexual function in a positive way (1) by decreasing urgency and (2) by increasing desire. Overall sexual frequency increased significantly after the surgery (p=0.047). There were also significant increases in the FSFI total (p=0.002), and domain scores for desire (p=0.004), lubrication (p=0.005), orgasm (p=0.043), satisfaction (p=0.007), and pain (p=0.015). There was no correlation between patient report of urinary symptom improvement and FSFI scores. In conclusion, sacral neuromodulation may improve sexual frequency and sexual function scores in subjects with urgency frequency and urge incontinence.
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Affiliation(s)
- Rachel N Pauls
- Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, OH, 45220, USA.
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Linderoth B, Foreman RD. Mechanisms of Spinal Cord Stimulation in Painful Syndromes: Role of Animal Models. PAIN MEDICINE 2006. [DOI: 10.1111/j.1526-4637.2006.00119.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Groen J, Ruud Bosch JLH, van Mastrigt R. Sacral Neuromodulation in Women With Idiopathic Detrusor Overactivity Incontinence: Decreased Overactivity but Unchanged Bladder Contraction Strength and Urethral Resistance During Voiding. J Urol 2006; 175:1005-9; discussion 1009. [PMID: 16469603 DOI: 10.1016/s0022-5347(05)00335-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated the effect of sacral (S3) nerve neuromodulation on voiding in women with idiopathic detrusor overactivity incontinence. MATERIALS AND METHODS Urodynamic measurements in all patients implanted in 1990 to 2003 were reconsidered. Patients were included if these measurements, which were done at baseline and after 6 months, could be analyzed completely and reliably. Maximum detrusor pressure, amplitude of the highest involuntary detrusor contraction and end fill volume were used as parameters characterizing the degree of detrusor overactivity. Urethral resistance and bladder contraction strength during voiding were characterized by the bladder outlet obstruction index, the urethral resistance factor, average pressure, the slope of the low pressure side of the pressure flow plot, the bladder contractility index and the bladder contraction strength parameter. RESULTS A total of 33 women were included. Detrusor overactivity parameters were significantly improved at followup. In addition, the supine position of the patient during filling in followup measurements proved less provocative with respect to overactivity than the standing position in the majority of measurements at baseline. Consequently bladder volumes at which voiding was initiated were considerably higher at followup. Changes in the parameters characterizing urethral resistance and bladder contraction strength during voiding were not unambiguous. However, exactly those parameters that appeared volume independent in a previous study were not significantly different. CONCLUSIONS Our study confirmed the depressant effect of sacral (S3) nerve neuromodulation on detrusor overactivity. No effect on urethral resistance and bladder contraction strength during voiding could be demonstrated using volume independent parameters.
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Affiliation(s)
- Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Starkman JS, Wolter CE, Scarpero HM, Milam DF, Dmochowski RR. Management of refractory urinary urge incontinence following urogynecological surgery with sacral neuromodulation. Neurourol Urodyn 2006; 26:29-35; discussion 36. [PMID: 17083097 DOI: 10.1002/nau.20360] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIMS We sought to explore our patient outcomes utilizing sacral neuromodulation in the management of refractory urinary urge incontinence following urogynecological surgical procedures. METHODS A total of 25 women with urinary urge incontinence following urogynecological surgery were selected for SNS therapy and retrospectively analyzed. All patients completed a comprehensive urological evaluation. Clinical data was recorded to determine outcomes and identify parameters that would be predictive of response to neuromodulation. Outcomes were determined via subjective patient questionnaire and graded as follows: significant response (> or =80% improvement), moderate response (> or =50% and <80% improvement), and poor response (<50% response). RESULTS Nineteen patients had a previous pubovaginal sling (10 with concomitant pelvic prolapse repair), 3 a previous retropubic suspension, and 3 a transperitoneal vesicovaginal fistula repair. Urethrolysis was performed in 4 patients to alleviate bladder outlet obstruction prior to sacral neuromodulation. Mean patient age was 59.8 years and length of follow-up was 7.2 months. Twenty-two women (88%) had the IPG placed during a Stage 2 procedure. Twenty patients maintained at least a 50% improvement in clinical symptoms at last follow-up and 6 patients were continent. Overall, the number of pads/day improved from 4.2 to 1.1 (P < 0.001). There were no significant differences in response to neuromodulation based upon age, duration of symptoms, type of surgery, or urodynamic parameters. CONCLUSION Sacral neuromodulation appears to be an effective therapy in patients with refractory urge incontinence following urogynecological surgery. Larger prospective studies with longer follow-up are needed to assess the durability of this therapeutic modality.
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Affiliation(s)
- Jonathan S Starkman
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, Tennessee 37232-2765, USA.
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