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Ippolito GMR, Palanjian RR, Mao-Draayer Y, Capizzano A, Barboglio-Romo P, Clemens JQ, Gupta P, Dunn R, O'Dell D, Daignault-Newton S, Van Til M, Cameron AP, Stoffel JT. A Prospective Observational Study of Posterior Tibial Nerve Stimulation in Multiple Sclerosis. Int Urogynecol J 2024; 35:1605-1612. [PMID: 38942931 DOI: 10.1007/s00192-024-05836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/17/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to examine the outcomes of posterior tibial nerve stimulation (PTNS) on bladder, bowel, and sexual health-related quality of life among a cohort of patients with multiple sclerosis (MS) with refractory lower urinary tract symptoms (LUTS). METHODS Patients with MS and refractory LUTS were recruited for a prospective, observational study using PTNS to treat their symptoms. Patients underwent 12 weekly 30-min PTNS sessions and bladder, bowel, and sexual symptoms were evaluated at baseline, 3, 12, and 24 months with voiding diaries, visual analog scales (VAS), and validated patient-reported questionnaires, including the American Urological Association Symptom Score (AUA-SS), Neurogenic Bladder Symptom Score (NBSS), Michigan Incontinence Symptom Index (M-ISI), Health Status Questionnaire, Sexual Satisfaction Scale, and Bowel Control Scale. RESULTS A total of 23 patients were recruited: 18 started PTNS and 14 completed 3 months of PTNS. Of the 18 who started PTNS, the mean age was 52 years (SD 12), 61% were female, 83% were white, and most patients had relapsing remitting (39%) MS. Baseline (n=18) and 3-month voiding (n=11) outcomes showed no significant change in number of voids or incontinence episodes. The median VAS symptom improvement was 49 (IQR 26.5, 26) and 9 (53%) patients elected for monthly maintenance PTNS. On paired analysis, there was a significant improvement in median change in NBSS, AUA-SS, and M-ISI. There was no significant change in bowel or sexual dysfunction. CONCLUSIONS This prospective, observational study of PTNS in patients with MS with refractory LUTS shows improvement in patient-reported bladder outcomes, but not in number of voids per day or bowel or bladder function.
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Affiliation(s)
| | - Rita R Palanjian
- Department of Urology, University of Arizona, Formerly University of Michigan Medical School, Tucson, AZ, USA.
| | - Yang Mao-Draayer
- Oklahoma Medical Research Foundation, Formerly Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - J Quentin Clemens
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rodney Dunn
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Diana O'Dell
- Department of Anesthesiology, University of Michigan, Formerly Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | | | - Monica Van Til
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Sacco R, Maino P, Koetsier E, Disanto G, Renard J, Digesu A, Gobbi C, Zecca C. Efficacy and safety of the implantable, magnetic resonance imaging-compatible StimRouter neuromodulation system in the treatment of refractory lower urinary tract symptoms in multiple sclerosis patients. Eur J Neurol 2024; 31:e16146. [PMID: 37975785 PMCID: PMC11235585 DOI: 10.1111/ene.16146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND PURPOSE Lower urinary tract symptoms (LUTS) significantly affect quality of life (QoL) of multiple sclerosis (MS) patients, and pharmacotherapy has limited efficacy. We investigated efficacy and safety of the implantable StimRouter neuromodulation system for treating refractory LUTS in MS. METHODS This prospective, single-center, clinical trial was conducted at the Multiple Sclerosis Center of Lugano, Switzerland, involving MS patients treated with self-administered percutaneous tibial nerve stimulation delivered by StimRouter over 24 weeks. Changes in video-urodynamic parameters as well as LUTS severity were measured by Overactive Bladder Questionnaire (OAB-q), QoL using the Multiple Sclerosis Quality of Life (MSQoL-54), and treatment satisfaction using a 1-10 visual analogue scale. Adverse events were also recorded. RESULTS Of 23 MS patients recruited, six had neurogenic detrusor overactivity (NDO), five had detrusor sphincter dyssynergia (DSD), and 12 had both NDO and DSD. Of patients with NDO, median bladder volume at first uninhibited contraction significantly increased from baseline to week 24 (median = 136 mL, interquartile range [IQR] = 101-244 mL vs. 343 mL, IQR = 237-391 mL; β = 138.2, p = 0.001). No significant changes of urodynamic parameters were found in patients with DSD. OAB-q symptom scores progressively decreased, and OAB-q quality of life scores increased (β = -0.50, p < 0.001 and β = 0.47, p < 0.001, respectively), whereas MSQoL-54 scores did not significantly change (β = 0.24, p = 0.084) in the overall population. Treatment satisfaction was overall high (median = 8, IQR = 6-9). No serious adverse events were recorded. CONCLUSIONS StimRouter represents a minimally invasive, magnetic resonance imaging-compatible, self-administered neuromodulation device leading to objective and subjective improvements of OAB symptoms and related QoL in MS patients with refractory LUTS.
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Affiliation(s)
- Rosaria Sacco
- Department of Neurology, Multiple Sclerosis CenterNeurocenter of Southern Switzerland, Regional Hospital (EOC) of LuganoLuganoSwitzerland
| | - Paolo Maino
- AnestesiologiaNeurocenter of Southern Switzerland, Regional Hospital (EOC) of LuganoLuganoSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera Italiana (USI)LuganoSwitzerland
| | - Eva Koetsier
- AnestesiologiaNeurocenter of Southern Switzerland, Regional Hospital (EOC) of LuganoLuganoSwitzerland
| | - Giulio Disanto
- Department of Neurology, Multiple Sclerosis CenterNeurocenter of Southern Switzerland, Regional Hospital (EOC) of LuganoLuganoSwitzerland
| | - Julien Renard
- Urology ServiceOspedale Regionale di Bellinzona e Valli (EOC)BellinzonaSwitzerland
| | - Alex Digesu
- Department of UrogynaecologyImperial College Healthcare NHS TrustLondonUK
| | - Claudio Gobbi
- Department of Neurology, Multiple Sclerosis CenterNeurocenter of Southern Switzerland, Regional Hospital (EOC) of LuganoLuganoSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera Italiana (USI)LuganoSwitzerland
| | - Chiara Zecca
- Department of Neurology, Multiple Sclerosis CenterNeurocenter of Southern Switzerland, Regional Hospital (EOC) of LuganoLuganoSwitzerland
- Faculty of Biomedical SciencesUniversità della Svizzera Italiana (USI)LuganoSwitzerland
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Marzouk MH, Darwish MH, El-Tamawy MS, Morsy S, Abbas RL, Ali AS. Posterior tibial nerve stimulation as a neuromodulation therapy in treatment of neurogenic overactive bladder in multiple sclerosis: A prospective randomized controlled study. Mult Scler Relat Disord 2022; 68:104252. [PMID: 36274285 DOI: 10.1016/j.msard.2022.104252] [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: 08/12/2022] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND one of the major annoying disorders occurring in people with multiple sclerosis is lower urinary tract disorders (LUT). Urgency is considered the main one seriously influencing the quality of life. Neurogenic detrusor over activity (DOAB) is characterized by a hyperreflexic, overactive detrusor that responds quickly to low-intensity sensory input from general visceral afferent fibers. Overactivity has been claimed to induce random, uncontrolled contractions of the detrusor muscle, leading to intravesicular pressure rise, producing urgency, frequency, and consequently incontinence AIM: To demonstrate the therapeutic efficacy for posterior tibial nerve stimulation (PTNS) in neurogenic over active bladder (NOAB) in people with multiple sclerosis METHODS: The current trial is a prospective, randomized controlled study. Forty remitting relapsing males with MS with moderate NOAB symptoms were randomly assigned into two equal groups; control group (C) treated by selected therapeutic exercises program for strengthening pelvic floor muscles and an intervention group (ES) receiving an additional posterior tibial nerve electrical stimulation. Each session ranged from 45- 50 minutes, three days weekly for a month. Outcome measures were recorded before starting the treatment and after termination of the study intervention and included over active bladder symptoms score (OVBS) score, urodynamic parameters (uroflow, filling and voiding cystometry), and post voiding residual volume by abdominal ultrasound RESULTS: There was a significant improvement of all voiding parameters compared to baseline and the group C except frequency of urgency incontinence. A significant decrease was detected in post-treatment mean episodes number of nighttime frequency, urgency, urgency incontinence (1.65 ± 0.93, 1.2 ± 0.52 and 1.5 ± 0.76) respectively of the ES group compared to that of group C (3.05 ± 1.09, 2.25 ± 0.71 and 2.25 ± 1.06) (P < 0.01). There was a significant decrease in median post-treatment OVBS score 3 (3-3) compared to group C median score 5 (6-4). A statistically significant improvement was observed of all urodynamic parameters (bladder capacity and compliance, Detrusor overactivity (DO), maximum flow rate and post voidal residual volume in the ES group compared to the group C CONCLUSION: PTNS is a promising and potentially beneficial treatment option for NOAB symptoms in males with MS and superior to pelvic floor muscle training alone.
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Affiliation(s)
- Mohamed H Marzouk
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
| | - Moshera H Darwish
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
| | | | - Samer Morsy
- Department of Urology, Faculty of Medicine, Cairo University.
| | - Rami L Abbas
- Physical Therapy Department, Beirut Arab University.
| | - Ahmed S Ali
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
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Vecchio M, Chiaramonte R, DI Benedetto P. Management of bladder dysfunction in multiple sclerosis: a systematic review and meta-analysis of studies regarding bladder rehabilitation. Eur J Phys Rehabil Med 2022; 58:387-396. [PMID: 35102733 PMCID: PMC9980558 DOI: 10.23736/s1973-9087.22.07217-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the efficacy of rehabilitation programs for bladder disorders in patients with multiple sclerosis (MS) and to guide physicians in delineating therapeutic tools and programs for physiatrists, using the best current strategies. EVIDENCE ACQUISITION A search was conducted on PubMed, EMBASE, the Cochrane Library and Web of Science. Studies were eligible if they included adults with bladder disorders related to MS and described specific treatments of rehabilitation interest. The search identified 190,283 articles using the key words "multiple sclerosis" AND "rehabilitation" AND "urinary" OR "bladder," of which the reviewers analyzed 81 full-texts; 21 publications met the criteria and were included in the systematic review. EVIDENCE SYNTHESIS The systematic review identified the specific rehabilitation treatments reported in the current literature. The meta-analysis compared the scores and scales used to quantify bladder disorders due to MS, both before and after rehabilitation or in a comparison with a control group. CONCLUSIONS The present study suggests the need of a specific therapeutic protocol, based on the degree of disability and symptom complexity in patients with MS-related neurogenic lower urinary tract dysfunction (NLUTD). Particularly, the meta-analysis shows the effectiveness of peripheral tibial nerve stimulation (PTNS) and pelvic floor muscle training (PFMT) for neurogenic detrusor overactivity (NDO). However, the goal of physiotherapy is to treat incontinence without making urinary retention worse and vice-versa, reducing the loss of urine urgency, while ensuring the emptying of the bladder.
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Affiliation(s)
- Michele Vecchio
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy - .,Unit of Rehabilitation, Vittorio Emanuele Polyclinic, Catania, Italy -
| | - Rita Chiaramonte
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Wang CN, Chung DE. Neuromodulation for lower urinary tract symptoms in special populations. Neurourol Urodyn 2022; 41:1948-1957. [PMID: 35579275 DOI: 10.1002/nau.24954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023]
Abstract
AIMS Discuss the efficacy, safety, and future directions of neuromodulation in special populations of patients with neurological conditions. METHODS A literature review was done to find meta-analyses, review articles, studies, and case reports of the use of neuromodulation, either sacral neuromodulation or percutaneous tibial nerve stimulation, in patients with various neurological conditions of interest. RESULTS Sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) appear to be safe and effective in special neurological populations of patients with multiple sclerosis (MS), Parkinson's disease (PD), and spinal cord injury (SCI). The majority of publications are smaller retrospective case series. Outcomes appear similar to those seen in nonneurogenic patients but also partly depend on disability progression. Magnetic resonance imaging (MRI) compatibility has helped to improve eligibility for SNM in these special populations. CONCLUSIONS In a small number of studies, SNM and PTNS appear to be safe and effective in special neurological populations of patients with MS, PD, and SCI. MRI compatibility has helped to improve eligibility for SNM in these special populations. Studies looking at SNM are limited by a small number of subjects, lack of prospective trials, and selection bias. Larger, randomized studies with long-term follow up are needed to better predict response to SNM and PTNS in these populations.
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Affiliation(s)
- Connie N Wang
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
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van Merode NAM, Dawson S, Coulthard E, Henderson EJ, Rice CM, Rees J, Smith M, Strong E, Cotterill N, Huntley AL, Drake MJ. Assessment and Treatment of Nocturia in Neurological Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. Eur Urol Focus 2022; 8:33-41. [PMID: 35031351 DOI: 10.1016/j.euf.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Neurological disease can affect the rate of urine production and bladder storage function, increasing nocturia severity, with additional risks if mobility or cognition is impaired. OBJECTIVE To conduct a systematic review (SR) of nocturia in neurological diseases and achieve expert consensus for management in clinics without neurologist input. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 6262 titles and abstracts were screened and 43 studies were included for full-text screening. Eleven of these met the inclusion criteria and two studies were identified through other sources. The nominal group technique (NGT) was used to develop consensus in panel comprising experts and public representation. EVIDENCE SYNTHESIS Thirteen studies (seven in Parkinson's disease, five in multiple sclerosis) were included, all undertaken in secondary care. Neurological disease severity was incompletely described, and nocturia severity was generally measured subjectively. NGT consensus supported basic neurological assessment, and the use of bladder diaries where neurological impairment permits. Treatments include pelvic-floor muscle training, review of medications, risk mitigation, improving bowel function, therapy for overactive bladder syndrome (if urgency is reported in association with nocturia episodes), treatment of postvoid residual and desmopressin according to licence. Measures to improve mobility and mitigate risk when using the toilet overnight should be considered. Multifactorial issues such as obstructive sleep apnoea and hypoventilation must be considered. CONCLUSIONS Nocturia in neurological disease is complex and lacks a robust evidence base, with very little research done in the primary care context. Guidance should be pragmatic, with reduction of risk a key requirement, until a multidisciplinary evidence base can be developed. PATIENT SUMMARY People with a neurological disease can suffer severe sleep disturbance because of the need to pass urine several times overnight (called nocturia). We looked at published research and found very little information to help general practitioners in managing this condition. We assembled a group of experts to develop practical approaches for assessing and treating nocturia in neurological disease.
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Affiliation(s)
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Claire M Rice
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.
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Guitynavard F, Mirmosayyeb O, Razavi ERVS, Hosseini M, Hosseinabadi AM, Ghajarzadeh M, Azadvari M. Percutaneous posterior tibial nerve stimulation (PTNS) for lower urinary tract symptoms (LUTSs) treatment in patients with multiple sclerosis (MS): A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 58:103392. [DOI: 10.1016/j.msard.2021.103392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
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Pericolini M, Miget G, Hentzen C, Finazzi Agrò E, Chesnel C, Lagnau P, Haddad R, Grasland M, Amarenco G. Cortical, Spinal, Sacral, and Peripheral Neuromodulations as Therapeutic Approaches for the Treatment of Lower Urinary Tract Symptoms in Multiple Sclerosis Patients: A Review. Neuromodulation 2021; 25:1065-1075. [PMID: 34496454 DOI: 10.1111/ner.13525] [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: 05/02/2021] [Revised: 06/30/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is often associated with urological disorders, mainly urinary incontinence and retention, the management of which being necessary to improve patient's quality of life (QOL) and to reduce potential urological complications. Besides the classical treatments based mainly on anticholinergics and/or self-catheterization, several neuromodulation techniques have been tried in recent years to improve these urinary disorders. By this review, we aim at providing an overview of neuromodulation and electrostimulation approaches to manage urinary symptoms in MS patients. MATERIALS AND METHODS A literature search using MEDLINE was performed. Only papers in English, and describing the effects of neuromodulation in MS patients, were considered. RESULTS A total of 18 studies met inclusion criteria and were reviewed. Of them, four related to sacral neuromodulation (SNM), seven to percutaneous tibial nerve stimulation (PTNS), six to spinal cord stimulation (SCS), and one to transcranial magnetic stimulation (TMS). DISCUSSION PTNS and SNM seem to be effective and safe therapeutic options for treating lower urinary tract symptoms in MS patients principally in case of overactive bladder (OAB) symptoms. Similarly, also SCS and TMS have been shown to be effective, despite the very limited number of patients and the small number of studies found in the literature. Interestingly, these techniques are effective even in patients who do not respond well to conservative therapies, such as anticholinergics. Furthermore, given their safety and efficacy, stimulations such as PTNS could be considered as a first-line treatment for OAB in MS patients, also considering that they are often preferred by patients to other commonly used treatments.
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Affiliation(s)
- Martina Pericolini
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma, Rome, Italy.,GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Gabriel Miget
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Claire Hentzen
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Enrico Finazzi Agrò
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma, Rome, Italy
| | - Camille Chesnel
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Philippe Lagnau
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Rebecca Haddad
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Matthieu Grasland
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Gerard Amarenco
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
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Andersen K, Kobberø H, Pedersen TB, Poulsen MH. Percutaneous tibial nerve stimulation for idiopathic and neurogenic overactive bladder dysfunction: a four-year follow-up single-centre experience. Scand J Urol 2021; 55:169-176. [PMID: 33635171 DOI: 10.1080/21681805.2021.1885486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Overactive bladder (OAB) affects hundreds of millions of people worldwide and has significant detrimental effects on quality-of-life. Percutaneous tibial nerve stimulation (PTNS) is endorsed in the European guidelines of Urology as second-line therapy - on par with pharmacological treatment for women with OAB. METHODS This prospective cohort study describes our clinical experience with PTNS in a daily outpatient clinic, on a consecutive cohort. The cohort of 116 patients was mixed; including both men and women with idiopathic (iOAB) and neurogenic (nOAB) overactive bladder. Patients were treated with a 12-week course of PTNS followed by monthly maintenance treatment. Data were collected during 4 years. RESULTS The most common indication for PTNS was OAB with urge incontinence (53%) followed by OAB-dry and nocturia (both 16%). One hundred and ten (95%) patients completed follow-up and 68 patients (62%) continued to maintenance treatment. A total of 68 patients reported an effect on PROM, BD and ICIQ-OAB, which is the same 62% that continue in maintenance PTNS. A significant decline was seen in overall ICIQ-OAB score, with a median drop from 87 to 54, a significant decline in overall frequency and nocturia on bladder diary and a shift in pad test group in 19% of the incontinence patients. CONCLUSION PTNS shows an equally significant effect on men as well as women both in the iOAB and nOAB subgroups in a daily outpatient clinic. In our opinion, PTNS should be a standard treatment option available at urological departments, where both men and women in both sub-groups could benefit from treatment. Further randomized studies focusing on men with iOAB are needed.
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Affiliation(s)
- K Andersen
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - H Kobberø
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - T B Pedersen
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - M H Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Institute, University of Southern Denmark, Odense, Denmark
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Panicker JN, Sakakibara R. Lower Urinary Tract and Bowel Dysfunction in Neurologic Disease. Continuum (Minneap Minn) 2020; 26:178-199. [PMID: 31996628 DOI: 10.1212/con.0000000000000824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This article provides an overview of the clinical presentation, investigations, and treatment options for lower urinary tract and bowel dysfunction in patients with neurologic diseases. RECENT FINDINGS The site of the neurologic lesion influences the pattern of lower urinary tract dysfunction. Antimuscarinic agents are first-line management for urinary incontinence; however, the side effect profile should be considered when prescribing them. β3-Receptor agonists are a promising alternative oral medication. Botulinum toxin injections into the detrusor have revolutionized the management of neurogenic detrusor overactivity.Bowel dysfunction commonly presents as constipation and fecal incontinence. Gastrointestinal emergencies may arise, including intestinal pseudoobstruction, intussusception, volvulus, and stercoral ulcer (ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation). Bowel function tests in neurologic patients often show a combination of slow transit and anorectal dysfunction. Management for slow transit constipation includes bulking agents, softening agents, yogurt/probiotics, and prokinetic agents. Suppositories, botulinum toxin injections, and transanal irrigation are options for managing anorectal constipation. SUMMARY Functions of the lower urinary tract and bowel are commonly affected in neurologic disease. Neurologists play an important role in assessing lower urinary tract and bowel symptoms in their patients and planning treatment strategies, often in collaboration with specialist teams.
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Sacco R, Braga A, Disanto G, Digesu GA, Maino P, Koetsier E, Caccia G, Serati M, Renard J, Gobbi C, Zecca C. Effectiveness of percutaneous posterior tibial nerve stimulation for the management of bowel dysfunction in multiple sclerosis patients. Mult Scler 2020; 27:1577-1584. [PMID: 33179574 DOI: 10.1177/1352458520972267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neurogenic bowel dysfunctions (NBDs) in the form of both fecal incontinence (FI) and functional constipation (FC) are frequent in multiple sclerosis (MS) patients and significantly affect their quality of life. Therapeutic options are limited. OBJECTIVE To investigate effectiveness of percutaneous posterior tibial nerve stimulation (PTNS) in MS patients suffering from FI and FC. METHODS Prevalence and severity of FI and FC were prospectively collected among MS patients undergoing 12 weeks of PTNS for neurogenic bladder. The Cleveland Clinic Fecal Incontinence Score (CCFIS) and the Rome III criteria were used to define FI and FC, respectively. Subjective treatment satisfaction was estimated using the Benefit Satisfaction and Willingness to Continue (BSWC) questionnaire. RESULTS A total of 60 patients undergoing PTNS suffered from NBDs (25 FI+/FC+, 5 FI+/FC-, 30 FI-/FC+). Median CCFIS decreased after PTNS from 12.0 (11.0-13.0) to 8.5 (7.0-11.0, p < 0.001), with particular improvements in liquid and flatal incontinence, pads' need, and lifestyle restrictions. Seven patients became FC free after PTNS and no patients developed FC during the study (p = 0.023). More than 50% of the patients were satisfied and willing to continue PTNS at study end. CONCLUSION PTNS represents a valid minimally invasive alternative treatment for MS patients suffering from NBDs.
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Affiliation(s)
- Rosaria Sacco
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Giulio Disanto
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | | | - Paolo Maino
- Anestesiologia, Ospedale Regionale di Lugano, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Eva Koetsier
- Anestesiologia, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Julien Renard
- Urology, Ospedale Regionale di Bellinzona e Valli-San Giovanni Bellinzona, Bellinzona, Switzerland
| | - Claudio Gobbi
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center (MSC), Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland/Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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12
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Abstract
AbstractLower urinary tract dysfunction is a common sequel of neurological disease resulting in symptoms that significantly impacts quality of life. The site of the neurological lesion and its nature influence the pattern of dysfunction. The risk for developing upper urinary tract damage and renal failure is considerably lower in patients with slowly progressive nontraumatic neurological disorders, compared with those with spinal cord injury or spina bifida. This acknowledged difference in morbidity is considered when developing appropriate management algorithms. The preliminary evaluation consists of history taking, and a bladder diary and may be supplemented by tests such as uroflowmetry, post-void residual measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the clinical indications. Incomplete bladder emptying is most often managed by intermittent catheterization, and storage dysfunction is managed by antimuscarinic medications. Intra-detrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. In select patients, reconstructive urological surgery may become necessary. An individualized, patient-tailored approach is required for the management of lower urinary tract dysfunction in this special population.
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Affiliation(s)
- Jalesh N. Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, United Kingdom
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13
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Xu L, Zhang Y, Min X, Li L, Ling Q, Xu S, Liu L, Cao P, Wang L, Wang J, Du G. Refractory lower urinary tract symptoms in patients with lumbar disc hernia relieved by non-surgical treatment. World J Urol 2020; 39:1597-1605. [PMID: 32613324 DOI: 10.1007/s00345-020-03330-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Refractory lower urinary tract symptoms (LUTS) coexisting with lumbar disc hernia (LDH) have been shown to resolve following LDH surgery, implying that LDH causes these LUTS. The purpose of this study was to report outcomes in patients with refractory LUTS and LDH following non-surgical treatment targeting LDH. METHODS A retrospective cohort study was conducted using outpatient data collected at Tongji Hospital, China, between 2016 and 2018. This study included 131 adult patients with refractory LUTS and LDH. Patients were stratified into two groups. Group A underwent non-surgical treatment for LDH plus pharmacological treatment for LUTS. Group B underwent only pharmacological treatment for LUTS. The International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) score, and uroflowmetry were used to evaluate outcomes. RESULTS In group A, following treatment, the maximum flow rate (Qmax) increased by 3.92 ml/s (p < 0.001), the IPSS reduced by 5.99 points (p < 0.001), and the QoL score decreased by 1.51 points (p < 0.001). In group B, the Qmax increased by 0.09 ml/s (p = 0.833), the IPSS reduced by 0.72 points (p = 0.163), and the QoL score decreased by 0.07 points (p = 0.784). CONCLUSIONS LUTS can be relieved by a combination of pharmacological treatment for LUTS and non-surgical treatment for LDH in some refractory LUTS patients with LDH. MRI is recommended for these patients.
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Affiliation(s)
- Lei Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Yong Zhang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Xiangde Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Lina Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Shengfei Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Libo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Peng Cao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Jianming Wang
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Guanghui Du
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China.
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14
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Managing Urological Disorders in Multiple Sclerosis Patients: A Review of Available and Emerging Therapies. Int Neurourol J 2020; 24:118-126. [PMID: 32615673 PMCID: PMC7332813 DOI: 10.5213/inj.2040028.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/18/2020] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis (MS) is a progressive neurological autoimmune disease with a diverse range of urological symptomatology, and most MS patients experience 1 or more moderate to severe urinary symptoms, as well as bladder and/or sexual disorders. Urologists play the director's role in evaluating and treating these patients. Therefore, identifying the proper evaluation tools and the most suitable therapeutic options for specific patients requires a thorough understanding of this disease process.
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15
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Polat Dunya C, Tulek Z, Kürtüncü M, Panicker JN, Eraksoy M. Effectiveness of the transcutaneous tibial nerve stimulation and pelvic floor muscle training with biofeedback in women with multiple sclerosis for the management of overactive bladder. Mult Scler 2020; 27:621-629. [DOI: 10.1177/1352458520926666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Overactive bladder (OAB) is common in patients with multiple sclerosis (MS) with a limited number of treatment options. Objective: To investigate the effect of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on OAB symptoms in female MS patients. Methods: This study was conducted at the outpatient MS clinic in Istanbul. At baseline bladder diary, post-voiding residue (PVR), OAB, and Qualiveen Scales (QoL: Quality of Life; Siup: Specific Impact of Urinary Problems on QoL) were assessed. Patients were allocated to receive TTNS or PFMT daily for 6 weeks and reevaluated using the same tests. Results: Fifty-five patients (TTNS = 28, PFMT = 27) were included. Compared with baseline, both TTNS and PFMT groups improved in terms of OAB ( p = 0.0001, p = 0.0001), Qualiveen-siup ( p = 0.0001, p = 0.0001), Qualiveen-QoL ( p = 0.002, p = 0.006), PVR ( p = 0.0001, p = 0.21), frequency ( p = 0.0001, p = 0.69), nocturia ( p = 0.0001, p = 0.19), urgency ( p = 0.0001, p = 0.0001), and urge incontinence ( p = 0.0001, p = 0.0001). Between-group comparisons showed significant differences in 24-hour frequency ( p = 0.002) in favor of TTNS. Conclusion: Our study demonstrates the efficacy of both TTNS and PFMT for managing OAB symptoms in MS, associated with a significant impact on QoL, but did not show superiority of the methods. Further studies are needed to explore differences between these two non-invasive treatments.
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Affiliation(s)
- Cansu Polat Dunya
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeliha Tulek
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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16
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Lane GI, Mao-Draayer Y, Barboglio-Romo P, Clemens JQ, Gupta P, Dunn R, Qin Y, Cameron AP, Stoffel JT. A prospective observational cohort study of posterior tibial nerve stimulation in patients with multiple sclerosis: design and methods. BMC Urol 2020; 20:58. [PMID: 32460741 PMCID: PMC7251681 DOI: 10.1186/s12894-020-00629-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posterior tibial nerve stimulation (PTNS) is a promising treatment for lower urinary tract symptoms (LUTS) in patients with MS. However, long term data focusing on PTNS impact on health-related quality of life (HRQOL), bowel and bladder symptoms are lacking. This paper describes a study protocol that examines the extended efficacy of PTNS on MS related bladder and bowel symptoms and resulting HRQOL. METHODS/DESIGN This is a single-centered, prospective, longitudinal, observational cohort study of patients with MS who suffer from LUTS and are refractory to two prior treatment modalities. Participants who have elected to pursue PTNS therapy for LUTS will be eligible. The primary outcome is the median number of urinary frequency and incontinence episodes on a 3-day voiding diary at 3, 12 and 24 months compared to baseline. Secondary outcome measures will include change in total AUA-SS, M-ISI, NBSS, SF-12, SSS and BCS scores from baseline The Expanded Disability Status Scale and magnetic resonance imaging will be evaluated at baseline and annually throughout the study. DISCUSSION This research protocol aims to expand on the existing literature regarding outcomes of PTNS in MS. Specifically, it will provide long term follow-up data on bladder, bowel, sexual and HRQOL outcomes. The completion of this study will provide longitudinal efficacy data of the impact of PTNS in MS patients. TRIAL REGISTRATION NCT04063852.
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Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA.
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Paholo Barboglio-Romo
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Rod Dunn
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Yongmei Qin
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
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Abstract
PURPOSE OF REVIEW To provide an overview of available electrical stimulation devices in neurogenic patients with lower urinary tract disease. RECENT FINDINGS It is advocated to do more studies in neurogenic patients as results seem promising and useful but most studies did not include neurogenic patients or neurogenic patients were not analyzed or reported separately. Most studies included a small heterogenous neurogenic group with multiple pathophysiologic origin focusing on effect of a treatment instead of results of a treatment in a specific neurogenic group. Neuromodulation or stimulation has the advantage that it acts on different organs, like bladder and bowel, so can treat neurogenic patients, who mostly suffer from multiple organ failure. SUMMARY Brindley procedure, sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) are available for a while already. The Brindley procedure (including sacral anterior root stimulation in combination with a rhizotomy of posterior sacral roots) is developed for selected spinal cord injury patient with a complete spinal injury, and has shown results for many years in neurogenic patients. An alternative to the rhizotomy is not established yet. SNM and PTNS are other modalities that are used in nonneurogenic patients, but are not yet indicated and much studied in neurogenic patients.
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Haddad R, Denys P, Arlandis S, Giannantoni A, Del Popolo G, Panicker JN, De Ridder D, Pauwaert K, Van Kerrebroeck PE, Everaert K. Nocturia and Nocturnal Polyuria in Neurological Patients: From Epidemiology to Treatment. A Systematic Review of the Literature. Eur Urol Focus 2020; 6:922-934. [PMID: 32192920 DOI: 10.1016/j.euf.2020.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/12/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Nocturia is among the most common and bothersome lower urinary tract symptoms (LUTS), but there is no clear consensus on how to identify and manage this symptom in the neurological population. OBJECTIVE To systematically review the literature about nocturia in neurological patients. EVIDENCE ACQUISITION Studies were identified by electronic search of Cochrane and Medline databases. The studies were included if their participants had acquired neurological pathology among multiple sclerosis (MS), Parkinson's disease (PD), stroke, spinal cord injury (SCI), and reported data on the epidemiology, aetiology, diagnosis, or treatment of nocturia. An independent extraction of the articles was performed by two authors using predetermined datasets, including quality-of-study indicators. EVIDENCE SYNTHESIS A total of 132 studies were included; 46 evaluated the epidemiology of nocturia, 28 the possible aetiologies, 10 the diagnostic tools, and 60 the treatments. Nocturia prevalence ranged from 15% to 96% depending on the pathology and definition used. It was one of the most frequently reported LUTS in PD and stroke patients. Several validated questionnaires were found to screen for nocturia in this population. Causalities were numerous: LUT, renal, sleep, cardiovascular dysfunctions, etc. Treatments targeted these mechanisms, with an overall risk of bias assessed as high or serious. The highest level of evidence was seen in MS patients: pelvic floor muscle training, cannabinoids, and desmopressin were effective, but not melatonin. In stroke patients, transcutaneous sacral and transcutaneous tibial nerve stimulation (TTNS) improved nocturia; in PD patients, TTNS, solifenacin, and rotigotine did not. CONCLUSIONS Nocturia is highly prevalent in patients with neurological disorders. Causalities and treatments are not different from the general population, but are poorly studied in neurological patients. PATIENT SUMMARY In this report, we looked at the published studies about nocturia-the fact of waking to void during the hours of sleep-in patients with neurological diseases. We found that nocturia is very frequent in this population, that the causes are the same as in the general population but may be combined, and that treatments are also the same but have an overall weak level of evidence. We conclude that more research is needed on this topic.
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Affiliation(s)
- Rebecca Haddad
- Urology Department, Ghent University Hospital, Ghent, Belgium.
| | - Pierre Denys
- Neuro-Urology Unit, PMR Department, Université de Versailles Saint Quentin, APHP, Raymond Poincaré Hospital, Garches, France
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, Siena, Italy
| | - Giulio Del Popolo
- Neuro-Urology & Spinal Unit Department, Careggi University Hospital, Firenze, Italy
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Dirk De Ridder
- Urology, University Hospitals KU Leuven, Leuven, Belgium
| | - Kim Pauwaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | | | - Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
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19
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Abstract
The function of the lower urinary tract is mainly storage and voiding of urine, which is coordinated by the nervous system. Various diseases of the nervous system may cause neuro-urological symptoms. Neuro-urological symptoms depend on the localization of the disease and the extension of the neurological lesion. About 80% of multiple sclerosis (MS) patients have neuro-urological symptoms within 10 years after diagnosis. In addition, 10% of MS patients may even present with voiding dysfunction at disease onset. In this review, different types of neuromodulation are discussed. The available studies suggest that sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) may be helpful in the neuromodulation of MS-related overactive bladder symptoms. These techniques may not only decrease the severity of symptoms but also significantly improve the quality of life of affected patients. Exploring the role of implantable tibial nerve stimulation devices in patients with MS could open new doors in the management of urgency and urgency incontinence in this patient group.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany/Society of Urological Research and Education (SURE), Heerlen, The Netherlands
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20
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Can Urol Assoc J 2019; 13:E157-E176. [PMID: 30763235 DOI: 10.5489/cuaj.5912] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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21
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Salatzki J, Liechti MD, Spanudakis E, Gonzales G, Baldwin J, Haslam C, Pakzad M, Panicker JN. Factors influencing return for maintenance treatment with percutaneous tibial nerve stimulation for the management of the overactive bladder. BJU Int 2019; 123:E20-E28. [PMID: 30552801 DOI: 10.1111/bju.14651] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify factors influencing return for maintenance percutaneous tibial nerve stimulation (PTNS) treatment after successful completion of a 12-week course of treatment for overactive bladder (OAB). PATIENTS AND METHODS Patients with OAB symptoms referred for PTNS treatment underwent 12 sessions of weekly PTNS treatment and were evaluated at baseline and week 12 using the International Consultation on Incontinence Questionnaire on OAB, the International Consultation on Incontinence Questionnaire on lower urinary tract symptom-related quality of life (ICIQ-LUTSqol) and a bladder diary (BD). Responders to treatment, evaluated using two patient-reported outcome measures, were invited to return for maintenance treatment when symptoms returned. A PTNS Service Evaluation Questionnaire was used to evaluate factors influencing return for maintenance treatment. RESULTS Seventy-three patients were evaluated (mean age 58.9 [±14.7] years, 72.6% women) and clustered into three groups: group 1 (n = 25) did not respond to 12 weekly sessions of PTNS treatment; group 2 (n = 17) responded to treatment but did not return for maintenance treatment and group 3 (n = 31) responded to treatment and returned for maintenance treatment. There were no significant differences in demographic characteristics, diagnosis, baseline symptom scores and BD variables among the three groups. Patients belonging to groups 2 and 3 experienced a significant improvement from baseline to week 12 in total OAB scores (group 2: -1.54 ± 1.85; group 3: -1.85 ± 2.28; P < 0.05); however, patients returning for maintenance treatment reported significant improvements specifically in nocturia (BD difference = -0.4 ± 0.7 [P < 0.05] and ICIQ-LUTSqol difference -0.48 ± 0.94 [P < 0.05]), and perceived benefits of the treatment with regard to their OAB symptoms compared to those not returning for maintenance treatment (difference between the two groups 25.6%; P = 0.030). Improvements in nocturia and perceived benefits predicted return for maintenance treatment based on a logistic regression analysis. Factors related to the need for repeat clinic visits, such as transportation, distance and time commitment, were not found to differ between the two groups. CONCLUSIONS Twelve-session weekly PTNS is a safe and effective treatment for OAB. Responders to treatment returning for maintenance PTNS more often reported significant improvements in nocturia and perceived benefits over time, compared to those not returning for maintenance treatment. The BD provides a more objective assessment of treatment outcome after PTNS treatment.
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Affiliation(s)
- Janek Salatzki
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK.,Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martina D Liechti
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Eleonora Spanudakis
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Gwen Gonzales
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Joanne Baldwin
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Mahreen Pakzad
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
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Detecting Bladder Biomarkers for Closed-Loop Neuromodulation: A Technological Review. Int Neurourol J 2018; 22:228-236. [PMID: 30599493 PMCID: PMC6312967 DOI: 10.5213/inj.1836246.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022] Open
Abstract
Neuromodulation was introduced for patients with poor outcomes from the existing traditional treatment approaches. It is well-established as an alternative, novel treatment option for voiding dysfunction. The current system of neuromodulation uses an open-loop system that only delivers continuous stimulation without considering the patient's state changes. Though the conventional open-loop system has shown positive clinical results, it can cause problems such as decreased efficacy over time due to neural habituation, higher risk of tissue damage, and lower battery life. Therefore, there is a need for a closed-loop system to overcome the disadvantages of existing systems. The closed-loop neuromodulation includes a system to monitor and stimulate micturition reflex pathways from the lower urinary tract, as well as the central nervous system. In this paper, we reviewed the current technological status to measure biomarker for closed-loop neuromodulation systems for voiding dysfunction.
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Seth JH, Gonzales G, Haslam C, Pakzad M, Vashisht A, Sahai A, Knowles C, Tucker A, Panicker J. Feasibility of using a novel non-invasive ambulatory tibial nerve stimulation device for the home-based treatment of overactive bladder symptoms. Transl Androl Urol 2018; 7:912-919. [PMID: 30505727 PMCID: PMC6256042 DOI: 10.21037/tau.2018.09.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate safety, acceptability and pilot efficacy of transcutaneous low-frequency tibial nerve stimulation (TNS) using a novel device as home-based neuromodulation. Methods In this single-centre pilot study, 48 patients with overactive bladder (OAB) (24 with neurogenic and 24 with idiopathic OAB) were randomized to use a self-applicating ambulatory skin-adhering device stimulating transcutaneously the tibial nerve at 1 Hz for 30 minutes, either once daily or once weekly, for 12 weeks. Changes in OAB symptoms and QoL were measured at baseline, weeks 4, 8, and 12 using validated scoring instruments (ICIQ-OAB and ICIQ-LUTSqol), 3-day bladder diary and a Global Response Assessment (GRA) at week 12. Results Thirty-four patients completed the study (idiopathic n=15, neurogenic n=19). No significant adverse effects were noted. Patients found the device acceptable. Eighteen patients (53%) reported a moderate or marked improvement in symptoms from the GRA. Between baseline and week-12, ICIQ-OAB part A sub-scores improved from mean (SD) 9.3 (2.5) to 7.5 (3.1), and from 9.1 (1.9) to 5.9 (1.7) in the daily and the weekly arms, respectively. ICIQ-LUTSqol part A sub-scores improved from mean (SD) 51 (12.8) to 44.2 (13.1) and 44.9 (9.0) to 35.9 (8.8) in the daily and the weekly arms, respectively. Bladder diary mean 24-hour frequency episodes improved from 11.5 to 8.8 at week 12 for both arms. Conclusions This novel ambulatory transcutaneous TNS (TTNS) device is safe and acceptable for use in patients reporting OAB symptoms as a form of home-based neuromodulation. A larger study however is required to confirm clinical efficacy.
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Affiliation(s)
- Jai H Seth
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Gwen Gonzales
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Mahreen Pakzad
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Arvind Vashisht
- Department of Uro-gynaecology, University College Hospital, London, UK
| | - Arun Sahai
- Department of Urology, Guy's Hospital, Kings College London, London, UK
| | - Charles Knowles
- Barts & The London SMD, Queen Mary University of London, London, UK
| | - Arthur Tucker
- Barts & The London SMD, Queen Mary University of London, London, UK
| | - Jalesh Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
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24
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Tibial Nerve and Sacral Neuromodulation in the Multiple Sclerosis Patient with Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0495-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Outcomes following percutaneous tibial nerve stimulation (PTNS) treatment for neurogenic and idiopathic overactive bladder. Clin Auton Res 2018; 30:61-67. [PMID: 30074101 DOI: 10.1007/s10286-018-0553-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Percutaneous tibial nerve stimulation is a minimally invasive neuromodulation technique for treating overactive bladder symptoms. The aim of this study was to assess safety, efficacy and impact on quality of life of percutaneous tibial nerve stimulation in neurological patients reporting overactive bladder symptoms. METHODS In this retrospective evaluation over 18 months at a tertiary healthcare centre, patients finding first-line treatments for overactive bladder ineffective or intolerable underwent a standard 12-week course of percutaneous tibial nerve stimulation (Urgent PC, Uroplasty). Symptoms were evaluated using standardised International Consultation on Incontinence Questionnaires and bladder diaries. RESULTS Of 74 patients (52 women, 22 men, mean age 56 years), 49 (66.2%) patients had neurological disorder [19 (25.7%) multiple sclerosis and 30 (40.5%) other neurological conditions] and 25 (33.8%) idiopathic overactive bladder. Overall for the entire cohort significant improvements were recorded after 12 weeks in the following domains: 24-h frequency on bladder diary - 1.67 (- 3.0, 0.33) (p = 0.002), number of incontinent episodes on bladder diary - 0.0 (- 1, 0) (p = 0.01), incontinence severity on bladder diary 0 (- 0.33, 0) (p = 0.007), OAB symptoms - 3 (- 11.5, 5) (p = 0.01), and quality of life - 16 (- 57, 6.5) (p = 0.004). There were no significant differences in outcomes between patients with idiopathic and neurogenic overactive bladder. CONCLUSIONS Percutaneous tibial nerve stimulation appears to be a possible promising alternative for patients with neurological disorder reporting overactive bladder symptoms who find first-line treatments either ineffective or intolerable. However, a properly designed study is required to address safety and efficacy.
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Neues zur symptomatischen MS-Therapie: Teil 3 – Blasenfunktionsstörungen. DER NERVENARZT 2017; 89:184-192. [DOI: 10.1007/s00115-017-0440-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin. Actas Urol Esp 2017; 41:465-470. [PMID: 28325529 DOI: 10.1016/j.acuro.2017.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. MATERIAL AND METHODS We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. RESULTS Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. CONCLUSIONS TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.
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Abstract
PURPOSE OF REVIEW Lower urinary tract and sexual dysfunction are commonly reported sequelae of neurologic disease and have a significant impact on quality of life. This article presents an up-to-date summary of the clinical presentation, investigations, and treatment options for urogenital dysfunction in patients with neurologic disease. RECENT FINDINGS The pattern of lower urinary tract dysfunction is influenced by the site of the neurologic lesion. The risk for developing upper urinary tract damage is considerably less in patients with slowly progressive nontraumatic neurologic disorders, as compared to those with spinal cord injury or spina bifida. Investigations such as urinalysis, ultrasonography, and urodynamics provide further information about the cause and nature of lower urinary tract dysfunction. Antimuscarinic agents are the first-line management of urinary incontinence; however, side effect profile and anticholinergic burden should be considered when prescribing medications. β3-Adrenergic receptor agonists are a promising alternative oral medication. Tibial and sacral neuromodulation have been shown to be effective for managing incontinence, as well as urinary retention due to Fowler syndrome. Intradetrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. SUMMARY Neurologic patients reporting urogenital symptoms require a comprehensive evaluation for planning a patient-tailored approach to management. Neurologists are increasingly inquiring about lower urinary tract and sexual functions and becoming involved in the management of these disorders.
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Nguyen LN, Chowdhury ML, Gilleran JP. Outcomes for Intermittent Neuromodulation as a Treatment for Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0411-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wibisono E, Rahardjo HE. Management of overactive bladder review: the role of percutaneous tibial nerve stimulation. MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v25i4.1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Overactive bladder (OAB) is a common condition that is experienced by around 455 million people (11% of the world population) and associated with significant impact in patients’ quality of life. The first line treatments of OAB are conservative treatment and anti-muscarinic medication. For the refractory OAB patients, the treatment options available are surgical therapy, electrical stimulation, and botulinum toxin injection. Among them, percutaneous tibial nerve stimulation (PTNS) is a minimally invasive option that aims to stimulate sacral nerve plexus, a group of nerve that is responsible for regulation of bladder function. After its approval by food and drug administration (FDA) in 2007, PTNS revealed considerable promise in OAB management. In this review, several non-comparative and comparative studies comparing PTNS with sham procedure, anti-muscarinic therapy, and multimodal therapy combining PTNS and anti-muscarinic had supportive data to this consideration.
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Therapeutic effects of electrical stimulation on overactive bladder: a meta-analysis. SPRINGERPLUS 2016; 5:2032. [PMID: 27995009 PMCID: PMC5127921 DOI: 10.1186/s40064-016-3737-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022]
Abstract
Background To systematically evaluate the therapeutic effect of electrical stimulation (ES) on overactive bladder (OB). Method
We retrieved information by searching databases from PubMed, CBM-disc, The Cochrane Library, ScienceDirect (from Elsevier publishers) and Springer publishers up to March 2016. We looked for randomized controlled trials that studied ES in OB treatment with subject headings and keywords using literature searches and manual retrieval. References of included studies were reviewed. Literature was screened independently by two investigators according to inclusion and exclusion criteria. After extracting data and evaluating their quality, meta-analysis was undertaken with RevMan v5.2. Results Ten randomized controlled trials involving 719 patients were included. Meta-analysis results demonstrated ES to have better effects for improving bladder compliance, reducing residual urine, and decreasing the frequency of enuresis in OB patients compared with the control group. ES elicited significantly better effects for diminishing the maximum detrusor pressure in children than in controls, but there was no significant difference in the maximum detrusor pressure between adults and controls. The therapeutic effect of ES combined with other therapies for increasing the maximum bladder capacity was better compared with other therapies alone. No significant difference was noted between ES alone and other therapies alone. Conclusions Based on current evidence, ES has certain effects on OBs. Severe adverse reactions are not observed. ES is safe, efficacious, and worthy of clinical use.
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Tracey JM, Stoffel JT. Secondary and tertiary treatments for multiple sclerosis patients with urinary symptoms. Investig Clin Urol 2016; 57:377-383. [PMID: 27847911 PMCID: PMC5109793 DOI: 10.4111/icu.2016.57.6.377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis patients with refractory urinary symptoms after treatment with behavioral therapy and medications still have treatment options. Prior to starting treatments, baseline symptoms should be assessed and treatment goals thoroughly discussed. Catheterization, botulinum toxin, and reconstructive surgery all can play a role in improving both safety and quality of life for these patients. Newer modalities, such as neuromodulation, may also have an increasing role in the future as more data develop regarding efficacy. Risks need to be weighed against any perceived benefit and disease status before more aggressive therapy is initiated.
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Affiliation(s)
- James M Tracey
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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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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Sadiq A, Brucker BM. Management of neurogenic lower urinary tract dysfunction in multiple sclerosis patients. Curr Urol Rep 2016; 16:44. [PMID: 26025495 DOI: 10.1007/s11934-015-0519-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple sclerosis (MS) can be a debilitating neurological condition that attributes significant morbidity to bladder dysfunction. Although many effective treatment options exist, symptomatic patients are often underdiagnosed and undertreated. The purpose of this article is to give an overview of the current literature including new screening tools to identify symptomatic patients and updates on treatment options including medications, botulinum toxin, and neuromodulation.
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Affiliation(s)
- Areeba Sadiq
- Department of Urology, New York University Langone Medical Center, 150 East 32nd Street, 2nd Floor, New York, NY, 10016, USA,
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Abstract
While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction.
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Affiliation(s)
- Melissa T Sanford
- Department of Urology, University of California, San Francisco, CA, USA
| | - Anne M Suskind
- Department of Urology, University of California, San Francisco, CA, USA
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Tibial Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review. Eur Urol 2015; 68:859-67. [DOI: 10.1016/j.eururo.2015.07.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/01/2015] [Indexed: 01/03/2023]
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Engeler DS, Meyer D, Abt D, Müller S, Schmid HP. Sacral neuromodulation for the treatment of neurogenic lower urinary tract dysfunction caused by multiple sclerosis: a single-centre prospective series. BMC Urol 2015; 15:105. [PMID: 26498275 PMCID: PMC4619407 DOI: 10.1186/s12894-015-0102-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sacral neuromodulation is well established in the treatment of refractory, non-neurogenic lower urinary tract dysfunction, but its efficacy and safety in patients with lower urinary tract dysfunction of neurological origin is unclear. Only few case series have been reported for multiple sclerosis. We prospectively evaluated the efficacy and safety of sacral neuromodulation in patients with multiple sclerosis. METHODS Seventeen patients (13 women, 4 men) treated with sacral neuromodulation for refractory neurogenic lower urinary tract dysfunction caused by multiple sclerosis were prospectively enrolled (2007-2011). Patients had to have stable disease and confirmed neurogenic lower urinary tract dysfunction. Voiding variables, adverse events, and subjective satisfaction were assessed. RESULTS Sixteen (94 %) patients had a positive test phase with a >70 % improvement. After implantation of the pulse generator (InterStim II), the improvement in voiding variables persisted. At 3 years, the median voided volume had improved significantly from 125 (range 0 to 350) to 265 ml (range 200 to 350) (p < 0.001), the post void residual from 170 (range 0 to 730) to 25 ml (range 0 to 300) (p = 0.01), micturition frequency from 12 (range 6 to 20) to 7 (range 4 to 12) (p = 0.003), and number of incontinence episodes from 3 (range 0 to 10) to 0 (range 0 to 1) (p = 0.006). The median subjective degree of satisfaction was 80 %. Only two patients developed lack of benefit. No major complications occurred. CONCLUSIONS Chronic sacral neuromodulation promises to be an effective and safe treatment of refractory neurogenic lower urinary tract dysfunction in selected patients with multiple sclerosis.
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Affiliation(s)
- Daniel S Engeler
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Daniel Meyer
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Dominik Abt
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
| | - Hans-Peter Schmid
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
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Canbaz Kabay S, Kabay S, Mestan E, Cetiner M, Ayas S, Sevim M, Ozden H, Karaman HO. Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12-months results. Neurourol Urodyn 2015; 36:104-110. [PMID: 26352904 DOI: 10.1002/nau.22868] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/04/2015] [Indexed: 11/11/2022]
Abstract
AIMS The aim of this study is to determine the sustained therapeutic efficacy and treatment intervals for PTNS in NOAB with MS, offering periodic additional treatments during 1 year in patients who completed an initial course of 12 consecutive weekly sessions. METHODS A total of 34 patients enrolled to the PTNS treatment and 21 patients completed the 1 year PTNS treatment with a tapering protocol of 6, 9, and 12 months of therapy, respectively. After 12 weeks of therapy, PTNS was applied at 14 day intervals for 3 months, 21 day intervals for 3 months, and 28 day intervals for 3 months. The patients completed a 3-day voiding diary at 3rd, 6th, 9th, and 12th month. The patients requested to complete validated questionnaires (ICIQ-SF, OAB-V8, OAB-q SF) were carried out within 3-month intervals thereafter during their enrolment in the study. RESULTS A total of 21 patients were enrolled in the study. Of these 5 (23.8%) were men and 16 (76.2%) women. The improvements for all voiding diary parameters were significant in the 6th, 9th, and 12th months when compared with baseline. Mean values between baseline and 12 month parameters suggested that daytime frequency decreased by 5.4 voids daily, urge incontinence decreased by 3.4 episodes daily, urgency episodes decreased by 7.4 episodes daily, nocturia decreased by 2.6 voids, and voided volume improved by a mean of 72.1 cc. CONCLUSION These results have demonstrated NOAB symptom improvement in MS patients can be achieved with 12 weekly PTNS treatments which show excellent durability over 12 months. Neurourol. Urodynam. 36:104-110, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Sibel Canbaz Kabay
- Department of Neurology, Dumlupinar University Faculty of Medicine, Kutahya, Turkey
| | - Sahin Kabay
- Department of Urology, Dumlupinar University Faculty of Medicine, Kutahya, Turkey
| | - Emine Mestan
- Department of Urology, Dumlupinar University Faculty of Medicine, Kutahya, Turkey
| | - Mustafa Cetiner
- Department of Urology, Dumlupinar University Faculty of Medicine, Kutahya, Turkey
| | - Selahattin Ayas
- Department of Neurology, Dumlupinar University Faculty of Medicine, Kutahya, Turkey
| | - Mehmet Sevim
- Department of Urology, Dumlupinar University Faculty of Medicine, Kutahya, Turkey
| | - Hilmi Ozden
- Department of Anatomy, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Handan Ozisik Karaman
- Department of Neurology, Canakkale 18 Mart University Faculty of Medicine, Canakkale, Turkey
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Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 2015; 14:720-32. [PMID: 26067125 DOI: 10.1016/s1474-4422(15)00070-8] [Citation(s) in RCA: 262] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms. Clinical assessment might include tests such as uroflowmetry, post-void residual volume measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the indication. Incomplete bladder emptying is most often managed by intermittent catheterisation, and storage dysfunction by antimuscarinic drugs. Intradetrusor injections of onabotulinumtoxinA have transformed the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. An individualised, patient-tailored approach is required for the management of LUT dysfunction associated with neurological disorders.
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK.
| | - Clare J Fowler
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Joussain C, Denys P. Electrical management of neurogenic lower urinary tract disorders. Ann Phys Rehabil Med 2015; 58:245-250. [PMID: 26321622 DOI: 10.1016/j.rehab.2015.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 11/16/2022]
Abstract
Management of lower urinary tract dysfunction (LUTD) in neurological diseases remains a priority because it leads to many complications such as incontinence, renal failure and decreased quality of life. A pharmacological approach remains the first-line treatment for patients with neurogenic LUTD, but electrical stimulation is a well-validated and recommended second-line treatment. However, clinicians must be aware of the indications, advantages and side effects of the therapy. This report provides an update on the 2 main electrical stimulation therapies for neurogenic LUTD - inducing direct bladder contraction with the Brindley procedure and modulating LUT physiology (sacral neuromodulation, tibial posterior nerve stimulation or pudendal nerve stimulation). We also describe the indications of these therapies for neurogenic LUTD, following international guidelines, as illustrated by their efficacy in patients with neurologic disorders. Electrical stimulation could be proposed for neurogenic LUTD as second-line treatment after failure of oral pharmacologic approaches. Nevertheless, further investigations are needed for a better understanding of the mechanisms of action of these techniques and to confirm their efficacy. Other electrical investigations, such as deep-brain stimulation and repetitive transcranial magnetic stimulation, or improved sacral anterior root stimulation, which could be associated with non-invasive and highly specific deafferentation of posterior roots, may open new fields in the management of neurogenic LUTD.
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Affiliation(s)
- C Joussain
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France.
| | - P Denys
- Department of Physical Medicine and Rehabilitation, Raymond-Poincaré Hospital, Medical School Paris Île-de-France Ouest, Inserm U1179 Versailles Saint-Quentin University, Versailles, France
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Zecca C, Panicari L, Disanto G, Maino P, Singh A, Digesu GA, Gobbi C. Posterior tibial nerve stimulation in the management of lower urinary tract symptoms in patients with multiple sclerosis. Int Urogynecol J 2015; 27:521-7. [PMID: 26245726 DOI: 10.1007/s00192-015-2814-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/24/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder dysfunction is a frequent symptom complex in patients with multiple sclerosis (MS) and often compromises the patient's quality of life. Pharmacotherapy has been poorly studied in the MS population showing contradictory results and reduced compliance owing to intolerable side effects. A new neuromodulation technique known as percutaneous tibial nerve stimulation (PTNS) has shown good efficacy and safety in the treatment of neurogenic and non-neurogenic lower urinary tract symptoms. In this article we review the literature and critically summarise the scientific evidence supporting the use of PTNS in the treatment of lower urinary tract symptoms (LUTS) in patients with MS. METHODS We performed a computer-aided literature search in PubMed and EMBASE up to January 2015 to identify randomised controlled trials, case-control trials and prospective observational cohort studies. RESULTS A total of 7 open-label, prospective studies and 313 MS patients were included. Three studies reported clinical and urodynamic outcomes at 3 to 9 months after PTNS; one study assessed the long-term efficacy of PTNS; two studies reported the acute effect of PTNS on urodynamic findings; one study assessed whether motor and sensory responses during PTNS could predict treatment outcome. None of the studies included a control group. CONCLUSIONS Despite the very limited data PTNS seems an effective and safe treatment option in the management of LUTS in patients with MS.
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Affiliation(s)
- Chiara Zecca
- Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Letizia Panicari
- Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Giulio Disanto
- Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Paolo Maino
- Anestesiologia, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Anand Singh
- St. Mary's Hospital, Imperial College School of Medicine, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - G Alessandro Digesu
- St. Mary's Hospital, Imperial College School of Medicine, London, UK.
- National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
- Urogynaecology Unit, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland.
- Department of Urogynaecology, S. Mary's Hospital, Academic Department of Obstetrics and Gynaecology, Mint Wing, South Wharf, W2 1NY, London, UK.
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
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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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Drake MJ. Management and rehabilitation of neurologic patients with lower urinary tract dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:451-68. [PMID: 26003260 DOI: 10.1016/b978-0-444-63247-0.00026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Diverse lower urinary tract problems arise in neurologic disease, caused by dysfunctions of the bladder and outlet, both during urine storage and voiding. Most neurologic diseases cause some lower urinary tract dysfunction (LUTD), and the type of dysfunction is related to the location of the nervous system lesion. Clinical evaluation requires identification of risk factors for major morbidity, particularly renal dysfunction, and mechanisms underlying symptoms. A holistic approach is needed to cover influential aspects (e.g., cognitive function, mobility, and urinary tract infections) and related issues (e.g., sexual function, bowel function, and autonomic dysreflexia), requiring a multidisciplinary team. Comprehensive history and examination are supported by a bladder diary, urinalysis, and renal assessment, supplemented by urodynamic tests. The simplest classification of neurogenic LUTD describes both bladder and sphincter function, cataloging each structure as normal, overactive, or underactive. Treatment aims to protect life expectancy and improve quality of life, noting the possibility of neurologic disease progression and comorbid disorders. Conservative measures include fluid advice and assessment of suitable containment products. Urine storage can be improved with antimuscarinic medications, bladder injections with botulinum neurotoxin A, and less established methods such as nerve stimulation, intravesical instillations, and beta-3 agonist. For severe storage dysfunction, sacral neuromodulation or surgery to improve reservoir function, increase outlet resistance, or divert the urinary tract may be needed. Voiding is usually replaced by intermittent or indwelling catheterization, which has largely superseded triggered reflex voiding, bladder expression, or sphincterotomy. Treatment selection is hampered by a limited, low-quality evidence base.
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The Shifting Paradigm of Treating Neurogenic Bladder Patients After the Introduction of Neuromodulation. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kovacevic M, Yoo PB. Reflex neuromodulation of bladder function elicited by posterior tibial nerve stimulation in anesthetized rats. Am J Physiol Renal Physiol 2015; 308:F320-9. [DOI: 10.1152/ajprenal.00212.2014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although posterior tibial nerve stimulation (PTNS) has been shown in both clinical and animal studies to elicit bladder-inhibitory reflexes, our understanding of the role of posterior tibial nerve (PTN) afferents that elicit these responses is significantly limited. To this end, we investigated the effects of frequency-dependant PTNS in urethane-anesthetized rats undergoing repeated urodynamic fills. Nerve stimulation trials (10 min) resulted in statistically significant inhibition of the urinary bladder, both during and after nerve stimulation ( P < 0.05). PTNS applied at 5 Hz resulted in both acute and prolonged changes that corresponded to 38.0% and 34.1% reductions in the bladder contraction frequency, respectively. In contrast, PTNS applied at 10 Hz could only elicit an acute decrease (22.9%) in bladder activity. Subsequent electrical activation of individual PTN branches (lateral or medial plantar nerves) confirmed that these bladder reflexes are mediated by specific subsets of the PTN trunk. Both acute and prolonged inhibition of the bladder were achieved by electrical stimulation of the lateral plantar (10 and 20 Hz) and medial plantar (5 and 10 Hz) nerves. Finally, we report a bladder-excitatory reflex that is elicited by electrical activation of either the PTN trunk or lateral plantar nerve at 50 Hz. This study shows that multiple bladder reflexes are tuned to specific subsets of nerve afferents and stimulation frequencies, each of which provide novel insights into the physiological effects of PTNS.
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Affiliation(s)
- Mario Kovacevic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; and
| | - Paul B. Yoo
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; and
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
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Lower urinary tract dysfunction in patients with multiple sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:371-81. [DOI: 10.1016/b978-0-444-63247-0.00021-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Parrillo L, Lamin E, Smith A. Non-pharmacologic options for the management of voiding dysfunction in multiple sclerosis. World J Clin Urol 2014; 3:152-160. [DOI: 10.5410/wjcu.v3.i3.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/03/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis is a neuroinflammatory condition that can cause significant bladder dysfunction manifesting either as overactive bladder or impaired bladder emptying. Patients will often complain of urgency, frequency, nocturia, urgency incontinence, hesitancy, straining to void, and incomplete bladder emptying. While these symptoms can be treated with pharmacologic agents, often patients will require more significant treatments. Patients should first be evaluated with urodynamics in order to adequately diagnose the pathologic condition causing their symptoms. These interventions include catheter use, injection of botulinum toxin, neuromodulation, urethral stenting, sphincterotomy, suprapubic catheter with bladder neck closure, bladder augmentation and urinary diversion. The purpose of this review is to examine the evidence supporting each of these treatment options so urologic providers can better provide for this unique and complex patient population.
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