1
|
Padilla-Fernández B, Hernández-Hernández D, Castro-Díaz DM. Current role of neuromodulation in bladder pain syndrome/interstitial cystitis. Ther Adv Urol 2022; 14:17562872221135941. [PMID: 36438605 PMCID: PMC9685149 DOI: 10.1177/17562872221135941] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/06/2022] [Indexed: 09/22/2023] Open
Abstract
Neuromodulation is recommended by major international guidelines as a fourth-line treatment in bladder pain syndrome/interstitial cystitis (BPS/IC) patients after failure of behavioural, oral and intravesical pharmacological treatments, including hydrodistension. A non-systematic review of studies identified by electronic search of MEDLINE was performed with no time limitation. A narrative synthesis of the existing evidence regarding the results of sacral, tibial and pudendal nerve stimulation in the management of BPS/IC was developed. Neuromodulation in pelvic chronic pain disorders, including BPS/IC, is a useful tool for refractory patients to conventional treatments. Sacral neuromodulation may be effective in patients with BPS without Hunner's lesions, and the effect seems to be maintained in the mid- and long-term. Posterior tibial nerve stimulation can be offered to patients with BPS/IC in the context of a multidisciplinary approach. When pudendal neuralgia is suspected, selective pudendal nerve stimulation has a high response rate. The aetiology of the pain can influence the outcomes in the mid- and long-term of the different neuromodulation approaches, thus careful diagnosis is recommended.
Collapse
Affiliation(s)
- Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario
Universitario de Canarias, Carretera La Cuesta, s/n, San Cristóbal de La
Laguna 38320, Tenerife, Spain
- Departamento de Cirugía, Facultad de Medicina,
Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - David Hernández-Hernández
- Department of Urology, Complejo Hospitalario
Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - David M. Castro-Díaz
- Department of Urology, Complejo Hospitalario
Universitario de Canarias, San Cristóbal de La Laguna, Spain
- Departamento de Cirugía, Facultad de Medicina,
Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| |
Collapse
|
2
|
Roy H, Offiah I, Dua A. Neuromodulation for Pelvic and Urogenital Pain. Brain Sci 2018; 8:brainsci8100180. [PMID: 30274287 PMCID: PMC6209873 DOI: 10.3390/brainsci8100180] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
Chronic pain affecting the pelvic and urogenital area is a major clinical problem with heterogeneous etiology, affecting both male and female patients and severely compromising quality of life. In cases where pharmacotherapy is ineffective, neuromodulation is proving to be a potential avenue to enhance analgesic outcomes. However, clinicians who frequently see patients with pelvic pain are not traditionally trained in a range of neuromodulation techniques. The aim of this overview is to describe major types of pelvic and urogenital pain syndromes and the neuromodulation approaches that have been trialed, including peripheral nerve stimulation, dorsal root ganglion stimulation, spinal cord stimulation, and brain stimulation techniques. Our conclusion is that neuromodulation, particularly of the peripheral nerves, may provide benefits for patients with pelvic pain. However, larger prospective randomized studies with carefully selected patient groups are required to establish efficacy and determine which patients are likely to achieve the best outcomes.
Collapse
Affiliation(s)
- Holly Roy
- Neurosurgery Department, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| | - Ifeoma Offiah
- Department of Obstetrics and Gynaecology, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| | - Anu Dua
- Department of Obstetrics and Gynaecology, University Hospitals Plymouth, Plymouth PL6 8DH, UK.
| |
Collapse
|
3
|
Dellis A, Papatsoris AG. Intravesical treatment of bladder pain syndrome/interstitial cystitis: from the conventional regimens to the novel botulinum toxin injections. Expert Opin Investig Drugs 2014; 23:751-7. [PMID: 24749738 DOI: 10.1517/13543784.2014.909406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Bladder pain syndrome (BPS) includes interstitial cystitis (IC) and is often used as a synonym of it (i.e., BPS/IC). It is associated with lower urinary tract symptoms as well as with negative cognitive, behavioral, sexual and/or emotional consequences. Unfortunately, none of the numerous existing oral and intravesical treatments have been effective for all of the BPS subtypes and therefore relevant research is ongoing. AREAS COVERED In this review, the authors analyze the existing literature for the intravesical treatment of BPS/IC with focus on the novel administration of botulinum toxin (BTX). Several intravesical drugs have been studied in the past, including lidocaine, heparin, pentosan polysulfate sodium, dimethyl sulfoxide, chondroitin sulfate, hyaluronic acid as well as investigational drugs such as GM-0111. Recently, intravesical submucosal injections of BTX have been studied in patients with BPS/IC. EXPERT OPINION Most of the recent studies use BTX-A with no serious adverse effects and with satisfactory results in patients who do not respond to oral or standard intravesical therapy. Nevertheless, there is no consensus regarding the best dosage scheme of BTX, the injection sites and the treatment intervals. BTX intravesical administration in patients with BPS/IC is a safe and efficient treatment option; yet the level of evidence of the initial studies is not high. There is still the need for large randomized controlled studies so that a consensus can be reached for the ideal BTX dosage, injection sites and intervals between treatments.
Collapse
Affiliation(s)
- Athanasios Dellis
- University of Athens, Areteion Hospital, 2nd Department of Surgery , Athens , Greece
| | | |
Collapse
|
4
|
Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC Urol 2013; 13:61. [PMID: 24274173 PMCID: PMC4222591 DOI: 10.1186/1471-2490-13-61] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/13/2013] [Indexed: 11/12/2022] Open
Abstract
Background Percutaneous Tibial Nerve Stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). Despite a number of publications produced in the last ten years, the role of PTNS in urinary tract dysfunctions remains unclear. A systematic review of the papers on PTNS has been performed with the aim to better clarify potentialities and limits of this technique in the treatment of OAB syndrome and in other above mentioned urological conditions. Methods A literature search using MEDLINE and ISI web was performed. Search terms used were “tibial nerve” and each of the already mentioned conditions, with no time limits. An evaluation of level of evidence for each paper was performed. Results PTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS, children with OAB/dysfunctional voiding and patients with neurogenic pathologies. No major complications have been reported. Randomized controlled trials are available only for OAB (4 studies) and CPP/PBS (2 studies). Level 1 evidence of PTNS efficacy for OAB is available. Promising results, to be confirmed by randomized controlled studies, have been obtained in the remaining indications considered. Conclusions PTNS is an effective and safe option to treat OAB patients. Further studies are needed to assess the role of PTNS in the remaining indications and to evaluate the long term durability of the treatment. Further research is needed to address several unanswered questions about PTNS.
Collapse
|
5
|
Nomiya A, Naruse T, Niimi A, Nishimatsu H, Kume H, Igawa Y, Homma Y. On- and post-treatment symptom relief by repeated instillations of heparin and alkalized lidocaine in interstitial cystitis. Int J Urol 2013; 20:1118-22. [DOI: 10.1111/iju.12120] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Akira Nomiya
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Takashi Naruse
- Department of Community Health Nursing; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Aya Niimi
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Hiroaki Nishimatsu
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Haruki Kume
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yasuhiko Igawa
- Continence Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yukio Homma
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| |
Collapse
|
6
|
|
7
|
Oottamasathien S, Jia W, McCoard L, Slack S, Zhang J, Skardal A, Job K, Kennedy TP, Dull RO, Prestwich GD. A murine model of inflammatory bladder disease: cathelicidin peptide induced bladder inflammation and treatment with sulfated polysaccharides. J Urol 2011; 186:1684-92. [PMID: 21855919 DOI: 10.1016/j.juro.2011.03.099] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Indexed: 10/17/2022]
Abstract
PURPOSE Studies show that LL-37 is a naturally occurring urinary defensin peptide that is up-regulated during urinary tract infections. Although normal urinary LL-37 levels are antimicrobial, we propose that increased LL-37 may trigger bladder inflammation. We further suggest that anti-inflammatory sulfated polysaccharides known as semi-synthetic glycosaminoglycan ether compounds can treat/prevent LL-37 mediated bladder inflammation. MATERIALS AND METHODS C57BL/6 mice were catheterized/instilled with LL-37 (320 μM, 150 μl) for 45 minutes. Animals were sacrificed at 12 and 24 hours, and tissues were examined using hematoxylin and eosin. Separate experiments were performed for myeloperoxidase to quantify inflammation. GM-1111 semi-synthetic glycosaminoglycan ether treatments involved instillation of 10 mg/ml for 45 minutes directly before or after LL-37. Tissues were harvested at 24 hours. To compare semi-synthetic glycosaminoglycan ether efficacy, experiments were performed using 10 mg/ml heparin. Finally, tissue localization of semi-synthetic glycosaminoglycan ether was examined using a fluorescent GM-1111-Alexa Fluor® 633 conjugate. RESULTS Profound bladder inflammation developed after LL-37. Greater tissue inflammation occurred after 24 hours compared to that at 12 hours. Myeloperoxidase assays revealed a 21 and 61-fold increase at 12 and 24 hours, respectively. Semi-synthetic glycosaminoglycan ether treatment after LL-37 showed mild attenuation of inflammation with myeloperoxidase 2.5-fold below that of untreated bladders. Semi-synthetic glycosaminoglycan ether treatment before LL-37 demonstrated almost complete attenuation of inflammation. Myeloperoxidase results mirrored those in controls. In heparin treated bladders minimal attenuation of inflammation occurred. Finally, instillation of GM-1111-Alexa Fluor 633 revealed urothelial coating, significant tissue penetration and binding to endovasculature. CONCLUSIONS We developed what is to our knowledge a new model of inflammatory bladder disease by challenge with the naturally occurring urinary peptide LL-37. We also noted that a new class of anti-inflammatory sulfated polysaccharides prevents and mitigates bladder inflammation.
Collapse
Affiliation(s)
- Siam Oottamasathien
- Department of Surgery and Division of Pediatric Urology, University of Utah, Salt Lake City, Utah 84113, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Rigaud J, Delavierre D, Sibert L, Labat JJ. [Specific treatments for painful bladder syndrome]. Prog Urol 2010; 20:1044-53. [PMID: 21056383 DOI: 10.1016/j.purol.2010.08.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/16/2010] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Painful bladder syndrome is defined as chronic pelvic pain present for more than 6 months, causing discomfort perceived as being related to the bladder and accompanied by a persistent and strong urge to urinate or urinary frequency. The purpose of this article is to review the treatment of painful bladder syndrome. MATERIAL AND METHODS A comprehensive review of the literature was performed by searching PUBMED for articles on specific treatments for painful bladder syndrome. RESULTS Many treatments have been proposed for the management of painful bladder syndrome: local intravesical treatments (glucosaminoglycan [pentosan polysulfate], dimethylsulfoxide [DMSO], heparin, bacillus Calmette-Guérin [BCG], anticholinergic agents [oxybutynin, etc.] or oral treatments [glucosaminoglycan (pentosan polysulfate), antihistamines, antidepressants, immunosuppressives, etc.]) with an action on the pathophysiology of this syndrome. The efficacy of these various treatments has been limited, with trials based on small numbers of patients and not always conducted according to a randomized, prospective design. Other salvage treatments (neuromodulation, botulinum toxin, surgery, etc.) have also been reported with limited efficacy, but allowing salvage of treatment failures. CONCLUSION The therapeutic management of painful bladder syndrome is complex. The large number of proposed treatment modalities present a limited efficacy with discordant results from one study to another making comparisons and analyses difficult.
Collapse
Affiliation(s)
- J Rigaud
- Clinique urologique, centre fédératif de pelvipérinéologie, hôpital Hôtel Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | | | | | | |
Collapse
|
9
|
Hanley RS, Stoffel JT, Zagha RM, Mourtzinos A, Bresette JF. Multimodal therapy for painful bladder syndrome / interstitial cystitis: pilot study combining behavioral, pharmacologic, and endoscopic therapies. Int Braz J Urol 2009; 35:467-74. [DOI: 10.1590/s1677-55382009000400011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2009] [Indexed: 11/21/2022] Open
Affiliation(s)
- Robert S. Hanley
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| | - John T. Stoffel
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| | - Ralph M. Zagha
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| | - Arthur Mourtzinos
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| | - John F. Bresette
- Anne Arundel Urology; Lahey Clinic Medical Center; Florida Medical Center, USA
| |
Collapse
|
10
|
van der Pal F, Heesakkers JPFA, Bemelmans BLH. Current opinion on the working mechanisms of neuromodulation in the treatment of lower urinary tract dysfunction. Curr Opin Urol 2006; 16:261-7. [PMID: 16770125 DOI: 10.1097/01.mou.0000232047.87803.1e] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Neuromodulation is a successful treatment for patients with refractory lower urinary tract dysfunction. In the recent years, more applications of various types and ways have been developed and put into clinical practice. It is important, therefore, for urologists to know the existing theories on the working mechanisms that explain the effect. Although much research has been devoted to this subject for the past 35 years, the working mechanism is still unknown. This review presents an overview of the different theories and research into the physiological background of neuromodulation during the past 3 decades with emphasis on recent developments. RECENT FINDINGS Specific receptors in the spinal cord have been identified, which are involved in the working mechanism of neuromodulation. The maximal effect of neuromodulation is not directly reached, indicating that neuromodulation induces learning changes (i.e. neural plasticity). The carry-over effect could be caused by negative modulation of excitatory synapses in the central micturition reflex pathway. SUMMARY Neuromodulation in the treatment of stress incontinence probably induces physiological changes in the sphincter muscles and pelvic floor. In the treatment of overactive bladder syndrome, nonobstructive voiding dysfunction and chronic pelvic pain, the mechanism of action seems to be more complicated. Most likely, it is a combination of the different suggested modes of action, involving the neuroaxis at different levels.
Collapse
Affiliation(s)
- Floor van der Pal
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | |
Collapse
|
11
|
Toft BR, Nordling J. Recent developments of intravesical therapy of painful bladder syndrome/interstitial cystitis: a review. Curr Opin Urol 2006; 16:268-72. [PMID: 16770126 DOI: 10.1097/01.mou.0000232048.81965.16] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Painful bladder syndrome/interstitial cystitis is a chronic sterile inflammatory disease of the bladder of unknown cause. It is characterized by bladder pain, urinary frequency, urgency, and nocturia. Although there are plenty of theories, the cause of the condition remains obscure. An abundance of treatments has been suggested, but very few have been subjected to proper controlled trials. This review focuses on the recently published literature on intravesical therapy strategies in painful bladder syndrome/interstitial cystitis. RECENT FINDINGS Bladder irrigation with different agents has been used during years in an attempt to treat painful bladder syndrome/interstitial cystitis. The background for this is the existing theories about urothelial dysfunction. The 'traditional' agent for glycosaminoglycan substitution is hyaluronic acid. Often used are heparin and dimethyl sulfoxide, the actions of which are not quite clear but supposedly on an anti-inflammatory basis. Other agents for intravesical treatment are Bacillus Calmette-Guerin vaccine and botulinum toxin, and some recent studies have pointed to resiniferatoxin and RDP58. SUMMARY Painful bladder syndrome/interstitial cystitis persists as a challenging syndrome in urology. Intravesical instillation therapy has basically not changed during the last few years, although some studies have disconfirmed some regimens. Intensive research may hopefully result in more effective treatments in the future.
Collapse
|
12
|
Brookoff D, Bennett DS. Neuromodulation in Intractable Interstitial Cystitis and Related Pelvic Pain Syndromes. PAIN MEDICINE 2006. [DOI: 10.1111/j.1526-4637.2006.00132.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Karsenty G, AlTaweel W, Hajebrahimi S, Corcos J. Efficacy of Interstitial Cystitis Treatments: A Review. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eeus.2005.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|