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Sarmento ALC, Sá BS, Vasconcelos AG, Arcanjo DDR, Durazzo A, Lucarini M, Leite JRDSDA, Sousa HA, Kückelhaus SAS. Perspectives on the Therapeutic Effects of Pelvic Floor Electrical Stimulation: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14035. [PMID: 36360918 PMCID: PMC9658412 DOI: 10.3390/ijerph192114035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Pelvic, perineal, and nervous lesions, which derive principally from pregnancy and childbirth, may lead to pelvic floor dysfunctions, such as organ prolapses and lesions in the nerves and muscles due to muscle expansion and physiology. It is estimated that 70% of women affected by this clinical picture have symptoms that do not respond to the classical treatments with antimuscarinic and anticholinergic drugs. Therefore, resorting to efficient alternatives and less invasive methods is necessary to assist this public health problem that predominantly affects the female population, which is more susceptible to the risk factors. This study aimed to perform an updated and comprehensive literature review focused on the effects of pelvic floor electrical stimulation, considering new perspectives such as a correlation between electric current and site of intervention and other molecular aspects, different from the present reviews that predominantly evaluate urodynamic aspects. For that purpose, PubMed and ScienceDirect databases were used to perform the search, and the Methodi ordinatio method was applied. With well-researched therapeutic effects, electrical stimulation induced promising results in histological, nervous, and molecular evaluations and spinal processes, which showed beneficial results and revealed new perspectives on ways to evoke responses in the lower urinary tract in a non-invasive way. Thus, it is possible to conclude that this type of intervention may be a non-invasive alternative to treat pelvic and perineal dysfunctions.
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Affiliation(s)
- Ana Lúcia Carneiro Sarmento
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
| | - Bruno Silva Sá
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
- Department of Biomedicine, University Centre of the Federal District (UDF), Brasília 70390-045, DF, Brazil
| | - Andreanne Gomes Vasconcelos
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
- Department of Biomedicine, University Centre of the Federal District (UDF), Brasília 70390-045, DF, Brazil
| | - Daniel Dias Rufino Arcanjo
- Laboratory of Functional and Molecular Studies in Physiopharmacology (LAFMOL), Department of Biophysics and Physiology, Federal University of Piauí (UFPI), Teresina 64049-550, PI, Brazil
| | - Alessandra Durazzo
- CREA-Research Centre for Food and Nutrition, Via Ardeatina 546, 00178 Rome, Italy
| | - Massimo Lucarini
- CREA-Research Centre for Food and Nutrition, Via Ardeatina 546, 00178 Rome, Italy
| | | | - Hugo Alves Sousa
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
| | - Selma Aparecida Souza Kückelhaus
- Research Center in Applied Morphology and Immunology (NuPMIA), Faculty of Medicine (FM), University of Brasília (UnB), Brasília 70910-900, DF, Brazil
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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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Li T, Feng XY, Feng XM, Lv JW, Lv TT, Wang SY. The short-term efficacy of electrical pudendal nerve stimulation versus intravesical instillation for the urethral pain syndrome: a randomized clinical trial. World J Urol 2021; 39:3993-3998. [PMID: 33934208 DOI: 10.1007/s00345-021-03698-2] [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: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Urethral pain syndrome is a chronic condition characterized by disturbing feeling or server pain sensed at the urethra without specific treatment. This double-center, two-arm controlled trial aimed to explore the efficacy of electrical pudendal nerve stimulation (EPNS) versus intravesical instillation (II) of heparin and alkalinized lidocaine for urethral pain syndrome (UPS). METHODS Eighty eligible patients took three sessions of EPNS, or 1 session of II per week, for 6 consecutive weeks. The primary end point was the change of pelvic pain and urgency/frequency symptom (PUF) score from baseline to week 6. Secondary outcome measures included changes of visual analogue scale (VAS) score and three sub-score extracted from PUF score. RESULTS The enrolled participants were all included in the intention-to-treat analyses, and baseline characteristics between the two groups were well balanced. The post-treatment PUF score decreased by 10.0 (7.00, 16.50) in the EPNS group, and by 7.0 (3.00, 10.00) in the II group. At the closure of treatment, the medians of changes in symptom score, bother score, pain-related score and VAS score were 6.50 (4.25, 10.00), 4.00 (2.00, 6.00), 6.00 (5.00, 8.00),4.50 (2.25, 6.00), respectively, in the EPNS group, and 4.00 (2.00, 7.00), 3.00 (1.00, 3.00), 3.00 (2.00, 6.00), 2.00 (1.00, 4.00), respectively, in the II group. All the between-group differences were statistically significant. CONCLUSION Compared with the II, the EPNS results in superior pain control and better relief of lower urinary tract symptoms, and deserves further attention. TRIAL REGISTRATION ClinicalTrials.gov (NCT03671993).
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Affiliation(s)
- Tian Li
- Shanghai Pudong Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Xin Y Feng
- Guangming Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Xiao M Feng
- The Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, 650 South Wanping Road, Shanghai, China
| | - Jian W Lv
- Department of Urology, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Ting T Lv
- Department of Urology, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Si Y Wang
- The Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, 650 South Wanping Road, Shanghai, China. .,Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Traditional Chinese and Western Medicine, Shanghai, China.
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Chen S, Wang S, Gao Y, Lu X, Yan J, Xuan L, Wang S. Bilateral electrical pudendal nerve stimulation as additional therapy for lower urinary tract dysfunction when stage II sacral neuromodulator fails: a case report. BMC Urol 2021; 21:37. [PMID: 33691669 PMCID: PMC7945661 DOI: 10.1186/s12894-021-00808-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes. Case presentation A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment. Conclusion EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00808-5.
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Affiliation(s)
- Shan Chen
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Siyou Wang
- Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Yunqiu Gao
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China
| | - Xiaolian Lu
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiasheng Yan
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shenhong Wang
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China.
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Sysoev Y, Bazhenova E, Lyakhovetskii V, Kovalev G, Shkorbatova P, Islamova R, Pavlova N, Gorskii O, Merkulyeva N, Shkarupa D, Musienko P. Site-Specific Neuromodulation of Detrusor and External Urethral Sphincter by Epidural Spinal Cord Stimulation. Front Syst Neurosci 2020; 14:47. [PMID: 32774243 PMCID: PMC7387722 DOI: 10.3389/fnsys.2020.00047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
Impairments of the lower urinary tract function including urine storage and voiding are widely spread among patients with spinal cord injuries. The management of such patients includes bladder catheterization, surgical and pharmacological approaches, which reduce the morbidity from urinary tract-related complications. However, to date, there is no effective treatment of neurogenic bladder and restoration of urinary function. In the present study, we examined neuromodulation of detrusor (Detr) and external urethral sphincter by epidural electrical stimulation (EES) of lumbar and sacral regions of the spinal cord in chronic rats. To our knowledge, it is the first chronic study where detrusor and external urethral sphincter signals were recorded simultaneously to monitor their neuromodulation by site-specific spinal cord stimulation (SCS). The data obtained demonstrate that activation of detrusor muscle mainly occurs during the stimulation of the upper lumbar (L1) and lower lumbar (L5-L6) spinal segments whereas external urethral sphincter was activated predominantly by sacral stimulation. These findings can be used for the development of neurorehabilitation strategies based on spinal cord epidural stimulation for autonomic function recovery after severe spinal cord injury (SCI).
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Affiliation(s)
- Yuriy Sysoev
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Department of Pharmacology and Clinical Pharmacology, Saint-Petersburg State Chemical Pharmaceutical University, Saint-Petersburg, Russia
| | - Elena Bazhenova
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Vsevolod Lyakhovetskii
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Gleb Kovalev
- Clinic of High Medical Technology named after N.I. Pirogov St. Petersburg State University, Saint-Petersburg, Russia
| | - Polina Shkorbatova
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Regina Islamova
- Institute of Chemistry, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Natalia Pavlova
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Oleg Gorskii
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Natalia Merkulyeva
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Dmitry Shkarupa
- Clinic of High Medical Technology named after N.I. Pirogov St. Petersburg State University, Saint-Petersburg, Russia
| | - Pavel Musienko
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia.,Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
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Coolen RL, Groen J, Blok B. Electrical stimulation in the treatment of bladder dysfunction: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:337-345. [PMID: 31572023 PMCID: PMC6750158 DOI: 10.2147/mder.s179898] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/24/2019] [Indexed: 01/24/2023] Open
Abstract
The urinary bladder has two functions: urine storage and voiding. Clinically, two major categories of lower urinary tract symptoms can be defined: storage symptoms such as incontinence and urgency, and voiding symptoms such as feeling of incomplete bladder emptying and slow urinary stream. Urgency to void with or without incontinence is called overactive bladder (OAB). Slow urinary stream, hesitancy, and straining to void with the feeling of incomplete bladder emptying are often called underactive bladder (UAB). The underlying causes of OAB or UAB can be either non-neurogenic (also referred to as idiopathic) and neurogenic, for example due to spinal cord injury or multiple sclerosis. OAB and UAB can be treated conservatively by lifestyle intervention or medication. In the case that conservative treatment does not provide sufficient benefit, electrical stimulation can be used. Sacral neurostimulation or neuromodulation (SNM) is offered as a third-line therapy to patients with non-neurogenic OAB or UAB. In SNM, the third or fourth sacral nerve root is stimulated and after a test period, a neuromodulator is implanted in the buttock. Until recently only a non-rechargeable neuromodulator was approved for clinical use. However, nowadays, a rechargeable sacral neuromodulator is also on the market, with similar safety and effectiveness to the non-rechargeable SNM system. The rechargeable device was approved for full body 1.5T and 3T MRI in Europe in February 2019. Regarding neurogenic lower urinary tract dysfunction, electrical stimulation only seems to benefit a selected group of patients.
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Affiliation(s)
- R L Coolen
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
| | - J Groen
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
| | - Bfm Blok
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
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