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Santos LTD, Matos GSR, Nogueira PC, Simis M. Effect of transcutaneous abdominal electrical stimulation in people with constipation due to spinal cord injuries: a pilot study. Rev Esc Enferm USP 2022; 56:e20210449. [PMID: 35848844 DOI: 10.1590/1980-220x-reeusp-2021-0449en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). METHOD This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. RESULTS This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). CONCLUSION Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.
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Affiliation(s)
| | | | - Paula Cristina Nogueira
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico Cirúrgica, São Paulo, SP, Brazil
| | - Marcel Simis
- Instituto de Medicina Física e Reabilitação, São Paulo, SP, Brazil
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Santos LTD, Matos GSR, Nogueira PC, Simis M. Efeito da eletroestimulação abdominal transcutânea no quadro de constipação em pessoas com lesão medular: estudo piloto. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0449pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Avaliar o efeito da eletroestimulação (EE) abdominal sobre a frequência de evacuações, a consistência e a quantidade de fezes em pessoas com constipação decorrente da lesão medular (LM). Método: Estudo piloto experimental do tipo crossover-randomizado em dois grupos de tratamento: convencional de reabilitação intestinal e convencional associado à EE com Functional Electrical Stimulation (FES) de 8 e 20 Hz aplicados na musculatura abdominal. Ambos os grupos em seguimento por duas semanas, com 30 minutos de sessão diária de EE. Os participantes estavam internados em um instituto de reabilitação da cidade de São Paulo. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados: Participaram do estudo 10 pessoas com LM, a maioria do sexo masculino (70%), com média de idade de 39 anos (DP = 16,37). A EE, associada ao tratamento convencional, mostrou-se mais eficaz no aumento da frequência evacuatória (p = 0,029) e na quantidade de fezes (p = 0,031). Conclusão: A EE abdominal associada ao tratamento convencional auxiliou no aumento da frequência evacuatória e na quantidade de fezes no quadro de constipação em pessoas com LM. Este estudo piloto servirá como base para um futuro ensaio clínico com maior amostragem e comprovação estatística.
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Affiliation(s)
| | | | | | - Marcel Simis
- Instituto de Medicina Física e Reabilitação, Brazil
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Schieferdecker S, Neudorfer C, El Majdoub F, Maarouf M. A Retrospective Case Series of High-Frequency Spinal Cord Stimulation (HF10-SCS) in Neurogenic Bladder Incontinence. Oper Neurosurg (Hagerstown) 2020; 17:14-20. [PMID: 30169840 DOI: 10.1093/ons/opy236] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/26/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Current treatment options for bladder disorders of neurogenic etiology often leave unsatisfactory results. Therefore, new and effective treatments must be investigated. High-frequency spinal cord stimulation (HF-SCS) at 10 kHz has proven to be effective in the treatment of refractory chronic back and leg pain. OBJECTIVE To evaluate the efficacy of HF-SCS at 10 kHz in alleviating lower urinary tract dysfunction and bladder incontinence in 5 patients with underlying neurological disease or spinal cord injury, through retrospective study. METHODS Urodynamic parameters such as voiding frequency, residual volume, episodes of incontinence, and the patients' subjective impression impairment of life were assessed and compared pre- and postoperatively. Reduction in pain intensity was assessed as change on the Numeric Rating Scale (NRS). RESULTS All 5 patients had significantly positive outcomes. Episodes of leakage per day improved by 83% on average. Quality of life questionnaires and subjective bother scale revealed an improvement of 36% and 57%, respectively. Individual symptoms among the patient group such as residual volume also responded to the treatment as well. Mean pain NRS of 8.6 cm was reduced to 3.9 cm (55%) at 6 mo follow-up. CONCLUSION HF-SCS at 10 kHz significantly alleviated symptoms of neurogenic bladder incontinence in patients suffering from neurological disease or spinal cord injury. However, larger and prospective, randomized studies are necessary to make a clear statement regarding the efficacy of this therapy in lower urinary tract dysfunction and bladder incontinence.
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Affiliation(s)
| | - Clemens Neudorfer
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Faycal El Majdoub
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Mohammad Maarouf
- Department for Stereotaxy and Functional Neurosurgery, Center of Neurosurgery Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
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Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory Monosymptomatic Nocturnal Enuresis: A Comparative Randomized Controlled Trial. Int Neurourol J 2018; 22:295-304. [PMID: 30599501 PMCID: PMC6312976 DOI: 10.5213/inj.1836142.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/25/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose To compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE). Methods Ninety children of both sexes aged 8–12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment. Results After training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups. Conclusions Both intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.
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Hajebrahimi S, Chapple CR, Pashazadeh F, Salehi-Pourmehr H. Management of neurogenic bladder in patients with Parkinson's disease: A systematic review. Neurourol Urodyn 2018; 38:31-62. [PMID: 30407660 DOI: 10.1002/nau.23869] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/14/2018] [Indexed: 01/22/2023]
Abstract
AIMS To assess the different treatment methods in management of neurogenic bladder (NGB) in patients with Parkinson's disease (PD). METHODS A systematic search was performed in Cochrane library, EMBASE, Proquest, Clinicaltrial.gov, WHO, Google Scholar, MEDLINE via PubMed, Ovid, ongoing trials registers, and conference proceedings in November 11, 2017. All randomized controlled trials (RCTs) or quasi-RCTs comparing any treatment method for management of NGB in patients with PD were included. The titles and abstracts of all identified studies were evaluated independently by two investigators. Once all of the potential related articles were retrieved, each author separately evaluated the full text of each article and the quality of the methodology of the selected studies using the Cochrane appraisal risk of bias checklist and then the data about the patient's outcomes was extracted. We registered the title in Joanna Briggs Institute (JBI) that is available in http://joannabriggs.org/research/registered_titles.aspx. RESULTS We included 41 RCTs or quasi-RCTs or three observational study with a total of 1063 patients that evaluated pharmacological, neurosurgical, botulinum toxin, electrical neuromodulation, and behavioral therapy effects on NGB. Among the included studies only solifenacin succinate double-blind, randomized, placebo-controlled study was assessed as low risk of bias, and treatment led to an improvement in urinary incontinence. CONCLUSIONS Although several interventions are available for treatment NGB in patients with PD, at present there is little or no evidence that treatment improves patient outcomes in this population. Additional large, well designed, randomized studies with improved methodology and reporting focused on patient-centered outcomes are needed.
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Affiliation(s)
- Sakineh Hajebrahimi
- Research Center for Evidence Based-Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fariba Pashazadeh
- Research Center for Evidence Based-Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
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Konschake M, Brenner E, Moriggl B, Hörmann R, Bauer S, Foditsch E, Janetschek G, Künzel KH, Sievert KD, Zimmermann R. New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study. Neurourol Urodyn 2016; 36:1069-1075. [PMID: 27490402 DOI: 10.1002/nau.23090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/13/2016] [Indexed: 11/09/2022]
Abstract
AIMS The aim was to develop a new laparoscopic technique for placement of a pudendal lead. METHODS Development of a direct, feasible and reliable minimal-invasive laparoscopic approach to the pudendal nerve (PN). Thirty-one embalmed human specimens were dissected for the relevant anatomic structures of the pelvis. Step-by-step documentation and analysis of the laparoscopic approach in order to locate the PN directly in its course around the medial part of the sacrospinous ligament and test this approach for feasibility. Landmarks for intraoperative navigation towards the PN as well as the possible position of an lead were selected and demonstrated. RESULTS The visible medial umbilical fold, the intrapelvine part of the internal pudendal artery, the coccygeus muscle and the sacrospinous ligament are the main landmarks. The PN traverses the medial part of the sacrospinous ligament dorsally, medially to the internal pudendal artery. The medial part of the sacrospinous ligament has to be exposed in order to display the nerve. An lead can be placed ventrally on the nerve or around it, depending on the lead type or shape. CONCLUSIONS A precise and reliable identification of the PN by means of laparoscopy is feasible with an easy four-step approach: (1) identification of the medial umbilical fold; (2) identification of the internal iliac artery; (3) identification of the internal pudendal artery and incision of the coccygeus muscle ('white line', arcuated line); and (4) exposition of the medial part of the sacrospinous ligament to display the PN.
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Affiliation(s)
- Marko Konschake
- Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria
| | - Erich Brenner
- Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria
| | - Bernhard Moriggl
- Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria
| | - Romed Hörmann
- Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria
| | - Sophina Bauer
- Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria
| | - Esra Foditsch
- Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria
| | - Günther Janetschek
- Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria
| | - Karl-Heinz Künzel
- Division for Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Tirol, Austria
| | - Karl-Dietrich Sievert
- Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria
| | - Reinhold Zimmermann
- Department of Urology and Andrology, SALK University Clinic and Paracelsus Private Medical University, Salzburg, Austria
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Tudor KI, Sakakibara R, Panicker JN. Neurogenic lower urinary tract dysfunction: evaluation and management. J Neurol 2016; 263:2555-2564. [DOI: 10.1007/s00415-016-8212-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 12/20/2022]
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Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis. Int Urogynecol J 2015; 27:347-54. [DOI: 10.1007/s00192-015-2771-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/18/2015] [Indexed: 01/14/2023]
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Sherif H, Abdelwahab O. Posterior tibial nerve stimulation as treatment for the overactive bladder. Arab J Urol 2013; 11:131-5. [PMID: 26558070 PMCID: PMC4442977 DOI: 10.1016/j.aju.2013.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/21/2013] [Accepted: 04/25/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of posterior tibial nerve stimulation (PTNS) as a treatment for the overactive bladder (OAB) resistant to medical treatment. PATIENTS AND METHODS The study included 60 patients, comprising 55 women (92%) and five men (8%) with a mean (SD) age of 41.4 (10.8) years, who presented to the Urology Department of Benha University Hospital from June 2010 to October 2012. All patients were assessed initially by taking a history, a physical examination, urine analysis, routine laboratory investigations, and a urodynamic evaluation in the form of flowmetry, cystometry, and a pressure-flow study in some cases. A voiding diary (daytime and night-time frequency, voiding volume, and leakage episodes) was completed by all patients, and all underwent 12 sessions of PTNS using a personal computer-based system, and were reassessed after the sixth session, at the end of the course, and at 3 and 6 months after the last session, using the same methods as in the baseline visit. RESULTS There was a statistically significant improvement in all the variables assessed. No infection or failure of the PTNS mechanism was detected while using the technique, but there were rare instances of minor bleeding and a temporary painful feeling at the insertion site. CONCLUSION PTNS is safe, and gives statistically significant improvements in the patient's assessment of OAB symptoms.
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Affiliation(s)
- Hammouda Sherif
- Urology Department, Faculty of Medicine, Benha University, Egypt
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Emami Z, Moosavi NS, Karimi M, Vaccaro AR, Rahimi-Movaghar V. S3 motor branch stimulation failure due to nerve fiber burning at the nerve-wire junction: A historical technical note. Surg Neurol Int 2013; 4:25. [PMID: 23532707 PMCID: PMC3604815 DOI: 10.4103/2152-7806.107901] [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] [Received: 09/26/2012] [Accepted: 12/19/2012] [Indexed: 11/04/2022] Open
Abstract
Background: Sacral nerve stimulation is a minimally invasive procedure to treat spinal cord injured (SCI) patients with overactive bladder syndrome or nonobstructive urinary retention that is refractory to conservative treatment. Methods: In this paper, we report a case of traumatic cervical SCI with quadriplegia and spastic bladder, which was managed by third sacral motor branch stimulation in 1998. Results: In this case, stimulation-induced burning of nerve fibers was seen microscopically during the implantation surgery. At 2 weeks after the index surgery, the stimulator was removed due to ineffectiveness. We hypothesize that the stimulation settings of our stimulator were not appropriate for neural stimulation and led to neural destruction, fibrosis, and treatment failure. Conclusion: The device settings of stimulators used in neural stimulation should be appropriate for direct neural stimulation otherwise they can lead to neural destruction and treatment failure.
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Affiliation(s)
- Zahra Emami
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Ding L, Song T, Yi C, Huang Y, Yu W, Ling L, Dai Y, Wei Z. Transcutaneous electrical nerve stimulation (TENS) improves the diabetic cytopathy (DCP) via up-regulation of CGRP and cAMP. PLoS One 2013; 8:e57477. [PMID: 23468996 PMCID: PMC3585412 DOI: 10.1371/journal.pone.0057477] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/22/2013] [Indexed: 12/21/2022] Open
Abstract
The objective of this study was to investigate the effects and mechanism of Transcutaneous Electrical Nerve Stimulation (TENS) on the diabetic cytopathy (DCP) in the diabetic bladder. A total of 45 rats were randomly divided into diabetes mellitus (DM)/TENS group (n = 15), DM group (n = 15) and control group (n = 15). The rats in the DM/TENS and TENS groups were electronically stimulated (stimulating parameters: intensity-31 V, frequency-31 Hz, and duration of stimulation of 15 min) for three weeks. Bladder histology, urodynamics and contractile responses to field stimulation and carbachol were determined. The expression of calcitonin gene-related peptide (CGRP) was analyzed by RT-PCR and Western blotting. The results showed that contractile responses of the DM rats were ameliorated after 3 weeks of TENS. Furthermore, TENS significantly increased bladder wet weight, volume threshold for micturition and reduced PVR, V% and cAMP content of the bladder. The mRNA and protein levels of CGRP in dorsal root ganglion (DRG) in the DM/TENS group were higher than those in the DM group. TENS also significantly up-regulated the cAMP content in the bladder body and base compared with diabetic rats. We conclude that TENS can significantly improve the urine contractility and ameliorate the feeling of bladder fullness in DM rats possibly via up-regulation of cAMP and CGRP in DRG.
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Affiliation(s)
- Liucheng Ding
- Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Song
- Department of Urology, Chinese PLA 454 Hospital, Nanjing, China
| | - Chaoran Yi
- Department of Urology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yi Huang
- Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Yu
- Department of Urology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Lin Ling
- Department of Urology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Yutian Dai
- Department of Urology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Zhongqing Wei
- Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail:
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The treatment of lower urinary tract symptoms in patients with multiple sclerosis: a systematic review. Curr Urol Rep 2012; 13:335-42. [PMID: 22886612 DOI: 10.1007/s11934-012-0266-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This is a systematic review on the treatment of lower urinary tract symptoms (LUTS) in patients with multiple sclerosis (MS). The heterogeneity of the outcome criteria did not allow a meta-analysis of the published evidence. In the last few decades, the therapeutic options for neurogenic bladder dysfunction have broadened. Despite this, no consensus has been reached as to the management of LUTD and LUTS in patients with MS, and the subject remains controversial. Bladder dysfunction is common in MS, affecting 80 %-100 % of patients during the course of the disease. Several studies have shown that urinary incontinence has a severe effect on patients' quality of life, with 70 % of patients classifying the impact bladder symptoms had on their life as "high" or "moderate." Moreover, the progressive feature of MS makes its treatment complex, since any achieved therapeutic result may be short-lived, with the possibility that symptoms will recur or develop de novo.
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Langmoen IA, Berg-Johnsen J. The brain-computer interface. World Neurosurg 2011; 78:573-5. [PMID: 22120219 DOI: 10.1016/j.wneu.2011.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 10/06/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Iver A Langmoen
- Department of Neurosurgery, Oslo University Hospital and University of Oslo, Oslo, Norway.
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Le NB, Kim JH. Expanding the Role of Neuromodulation for Overactive Bladder: New Indications and Alternatives to Delivery. CURRENT BLADDER DYSFUNCTION REPORTS 2011; 6:25-30. [PMID: 21461046 PMCID: PMC3061628 DOI: 10.1007/s11884-010-0074-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
From the time that it was granted US Food and Drug Administration approval, neuromodulation has secured a firm position in the treatment algorithm for overactive bladder. With neuromodulation, physicians were able to bridge the gap between the two ends of the treatment spectrum (medical therapy and open surgery). Sacral nerve stimulation has been the most widely used form of neuromodulation. Recent modifications to its design, namely the development of the tined lead and the launching of the refined InterStim II (Medtronic, Minneapolis, MN), have made sacral nerve simulation even less invasive and more effective. While InterStim is maintaining a level of success with these advancements, peripheral means of neuromodulation are being explored. The current literature takes a closer look at posterior tibial and pudendal nerve stimulation as alternatives to sacral nerve stimulation. The field of neuromodulation is also expanding in terms of the target patient population, as it is being used to treat children, patients with neurological disease, and others. As the role of neuromodulation increases, we must continue to assess its efficacy, safety, and cost-effectiveness in comparison to other therapeutic options.
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Affiliation(s)
- Ngoc-Bich Le
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Frank Clark Urology Center, 200 Medical Plaza, Suite 140, Los Angeles, CA 90025 USA
| | - Ja-Hong Kim
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Frank Clark Urology Center, 200 Medical Plaza, Suite 140, Los Angeles, CA 90025 USA
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de Sèze M, Raibaut P, Gallien P, Even-Schneider A, Denys P, Bonniaud V, Gamé X, Amarenco G. Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Neurourol Urodyn 2011; 30:306-11. [PMID: 21305588 DOI: 10.1002/nau.20958] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 05/18/2010] [Indexed: 12/21/2022]
Abstract
AIMS Electrostimulation is an established therapeutic option for neurogenic urinary disorders. The aim of this study was to investigate the efficacy of the noninvasive technique of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with multiple sclerosis (MS) and troublesome symptoms of an overactive bladder (OAB). METHODS A multicentric study enrolled 70 MS patients, suffering from OAB for a 3-month study period. INTERVENTION Daily sessions of 20 min of TPTNS were provided. No change of associated treatments during the study period. The primary outcome measurement was Urgency and Frequency reported by bladder diary and symptom score performed before the treatment (Day 0, D0) and at D30 and D90. The secondary outcomes measurements were continence, symptom score, quality of life, psychosocial burden at DO, D30, and D90 and cystometry at baseline, with and without TPTNS and at D90. RESULTS Clinical improvement of OAB was shown in 82.6% and 83.3% of the patients on D30 and D90, respectively, with significant improvement of primary and secondary outcomes compared to baseline. The initial acute cystometric response to TPTNS was positive in 51.2% of the patients (increase of >30% of cystometric capacity and/or reflex volume), without correlation with TPTNS clinical efficiency. The procedure was well tolerated. CONCLUSIONS Chronic TPTNS appears to be effective in the management of severe OAB in MS, without compromising bladder emptying or inducing side effect. Treatment may be effective even in the absence of an acute cystometric effect. Additional works are required to demonstrate long-term efficacy of TPTNS.
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Affiliation(s)
- Marianne de Sèze
- Physical Medicine and Neurorehabilitation Unit, Bordeaux University Hospital, EA 4136, Bordeaux University, Bordeaux, France.
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Stöhrer M, Pannek J. Harninkontinenz und neurogene Blasenfunktionsstörungen. NeuroRehabilitation 2010. [DOI: 10.1007/978-3-642-12915-5_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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