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Gish B, Langford B, Sobey C, Singh C, Abdullah N, Walker J, Gray H, Hagedorn J, Ghosh P, Patel K, Deer T. Neuromodulation for the management of chronic pelvic pain syndromes: A systematic review. Pain Pract 2024; 24:321-340. [PMID: 37726930 DOI: 10.1111/papr.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Chronic pelvic pain is a burdensome condition that involves multiple medical sub-specialties and is often difficult to treat. Sacral stimulation for functional bladder disease has been well established, but little large-scale evidence exists regarding utilization of other neuromodulation techniques to treat chronic pelvic pain. Emerging evidence does suggest that neuromodulation is a promising treatment, and we aim to characterize the use and efficacy of such techniques for treating chronic pelvic pain syndromes. MATERIALS AND METHODS A systematic review of the literature demonstrating the treatment of chronic pelvic pain syndromes with neuromodulation. Abstracts were reviewed and selected for inclusion, including case series, prospective studies, and randomized controlled trials (RCTs). Case studies and publications in abstract only were not included. The reporting for this systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search was performed using MEDLINE, Embase, Cochrane Library, PubMed, CINAHL, and Scopus. RESULTS A total of 50 studies were included in this review, three of which were randomized controlled trials, and the remaining were prospective and retrospective case series. The range of pelvic pain conditions treated included interstitial cystitis, peripheral neuralgia, pudendal neuralgia, gastrointestinal pain, urogenital pain, sacroiliac joint pain, and visceral chronic pelvic pain. We reported on outcomes involving pain, functionality, psychosocial improvement, and medication reduction. CONCLUSIONS Neuromodulation is a growing treatment for various chronic pain syndromes. Peripheral nerve stimulation was the least studied form of stimulation. Posterior tibial nerve stimulation appears to offer short-term benefit, but long-term results are challenging. Sacral nerve stimulation is established for use in functional bladder syndromes and appears to offer pain improvement in these patients as well. Dorsal root ganglion stimulation and spinal cord stimulation have been used for a variety of conditions with promising results. Further studies of homogeneous patient populations are necessary before strong recommendations can be made at this time, although pooled analysis may also be impactful.
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Affiliation(s)
- Brandon Gish
- Lexington Clinic Interventional Pain, Lexington, Kentucky, USA
| | - Brendan Langford
- Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher Sobey
- Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chahait Singh
- Empire Minimally Invasive Spine and Pain, New York, New York, USA
| | - Newaj Abdullah
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Walker
- Division of Pain Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hannah Gray
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Kiran Patel
- Lennox Hill Hospital, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, West Virginia, USA
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Parodi S, Kendall HJ, Terrone C, Heesakkers JPFA. Evolving types of pudendal neuromodulation for lower urinary tract dysfunction. Cent European J Urol 2024; 77:82-88. [PMID: 38645815 PMCID: PMC11032025 DOI: 10.5173/ceju.2023.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction Sacral neuromodulation and posterior tibial nerve stimulation for lower urinary tract dysfunction (LUTD) and overactive bladder yield good and reliable results. However, neuromodulation research is continuously evolving because there is still need for more patient-friendly treatment options in the therapeutic management of LUTD. Pudendal neuromodulation (PNM) has been emerging as a promising alternative treatment option for the last few decades. The aim of this study is to review the current state of the art of PNM. Material and methods A wide literature search was conducted in the field of PNM using Medline through the PubMed database and Elsevier using the Scopus database; a critical review of the results was then carried out. PNM has been studied in its various possible aspects: percutaneous PNM, transrectal/transvaginal PNM, and both percutaneous and transcutaneous dorsal genital nerve stimulation. Results Each technique was found to result in promising improvements in different clinical outcomes, with some trials reporting even better results than sacral neuromodulation. Conclusions As a result of a comparison between the various PNM techniques with both sacral neuromodulation and posterior tibial nerve stimulation, we think that PNM should be seen as seriously promising, and we believe it will expand the treatment options for overactive bladder. Even though several studies accordingly showed PNM to be safe and effective, a systematic review and meta-analysis were not feasible. PNM in its various techniques is a promising treatment for LUTD. Nevertheless, further research is needed to include it in treatment algorithms.
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Affiliation(s)
- Stefano Parodi
- Department of Urology, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
- Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Harry J Kendall
- Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Carlo Terrone
- Department of Urology, IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - John PFA Heesakkers
- Department of Urology, Maastricht University Medical Centre, Maastricht, the Netherlands
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Pelling M, Hammett J, Patil D. Long-Term Cost Analysis of Third-Line Treatment Options for Overactive Bladder. Urol Pract 2024; 11:62-69. [PMID: 37916945 DOI: 10.1097/upj.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION We aimed to analyze the long-term cost of overactive bladder third-line treatments. METHODS This insurance claims review analyzed the 2015 to 2020 MarketScan (MKS) claims data set subjects age ≥ 18, diagnosis of overactive bladder (OAB) using ICD-9/ICD-10 codes and receipt of treatment for percutaneous tibial nerve stimulation, sacral neuromodulation (SNM), or botulinum A. Age, gender, treatment types, and cost were extracted. Treatment costs were aggregated at the level of patient and treatment type for total payment and patient contribution by combining copay, coinsurance, and deductible. We used the Wilcoxon rank-sum test for continuous and chi-square test for categorical variables. SAS v9.4 was used for analyses. Significance was set at P < .05. RESULTS We identified 17,755 patients from the commercial claims MKS and 10,912 patients from the Medicare supplemental (MDC) database with mean age 50.7±11.1 and 75.5±7.6 years, respectively, who underwent ≥ 1 third-line OAB treatment. Patients receiving third-line treatment were predominantly female (84.9%, MKS, 74.8%, MDC). Long-term costs over a 15-year period were estimated. Percutaneous tibial nerve stimulation is the most expensive in terms of total net payment ($105,337.50 MKS, $94,102.50 MDC) and patient contribution ($9177.60 MKS, $3921.00 MDC). Total net payment for botulinum A was $67,968 (MSK), $54,261 (MDC), and patient contribution cost was $2850 (MSK), $1110 (MDC). The most cost-effective option was SNM in terms of both total net payment ($5179.10 MKS, $6099.00 MDC) and patient contribution ($59.10 MKS, $60.00 MDC). CONCLUSIONS SNM was the most cost-effective third-line treatment for OAB looking over a 15-year period in terms of both total net payment and patient contribution.
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Affiliation(s)
- Mary Pelling
- Emory University School of Medicine, Atlanta, Georgia
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Bressington MJ, Scholtz D, Hooshiary A, Vermeulen W, Burns T, Ordones F, Gilling P. Device evaluation: eCoin #x2013; implantable tibial nerve stimulator for overactive bladder. Expert Rev Med Devices 2023; 20:899-904. [PMID: 37691269 DOI: 10.1080/17434440.2023.2254678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/01/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Peripheral nerve stimulation has been demonstrated as a viable alternative to sacral nerve stimulation in managing refractory overactive bladder (OAB). New technologies allow the internalization of tibial nerve stimulators through various apparatuses. One such device, the eCoin, is a small, coin-shaped device that can be implanted adjacent to the tibial nerve that provides pre-programmed stimulation. AREAS COVERED We will review the literature on eCoin implantation, from proof of concept to mid-term data, with the longest period of follow-up being 12 months. All studies on this technology will be reviewed, along with an analysis of the current state of play in implantable neuromodulators for overactive bladder. Efficacy, durability, adverse events, and viability of eCoin as a long-term management option will be considered. EXPERT OPINION The eCoin device demonstrates promising early data for efficacy in managing overactive bladder symptoms. Complication rates remain low and are mostly related to wound healing following the initial placement of the device. Research into the continued improvement and modification of the device appears optimistic, but longer-term data still need to be obtained. Indeed, implantable PTNS have a role in the future management of overactive bladder, and devices such as eCoin will still need to prove a long-term benefit to be a mainstay of management.
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Affiliation(s)
| | | | | | - Wikus Vermeulen
- Urologist, Tauranga Hospital, Tauranga, New Zealand
- Honorary Senior Lecturer, University of Auckland, Auckland, New Zealand
| | | | - Flavio Ordones
- Urologist, Tauranga Hospital, Tauranga, New Zealand
- Honorary Senior Lecturer, University of Auckland, Auckland, New Zealand
| | - Peter Gilling
- Urologist, Tauranga Hospital, Tauranga, New Zealand
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Radinmehr H, Radnia N, Tabatabaei A, Asadi MR, Rahbar S, Talimkhani A, Irani AD, Hajvalie GR. Transcutaneous tibial neurostimulation and Solifenacin in urgent incontinence of postmenopausal women. Eur J Transl Myol 2023; 33:11358. [PMID: 37345495 PMCID: PMC10388598 DOI: 10.4081/ejtm.2023.11358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/24/2023] [Indexed: 06/23/2023] Open
Abstract
Symptoms of overactive bladder syndrome (OAB), including urinary incontinence, affect a person's quality of life and cause many personal, social and economic problems. Patients were randomly divided into three groups and received transcutaneous tibial nerve stimulation (cTTNS) with fixed parameters or with variable parameters (vTTNS) and Solifenacin drug. The main outcomes including quality of life questionnaire and OAB score and other secondary outcomes were evaluated before and after treatment for 6 weeks. ANOVA test did not show any significant difference between the three groups in quality of life score (p=0.672), OAB symptom score (p=0.159) and incontinence severity (p=0.422). The t-test demonstrated that the post treatment average quality of life score, OAB score, and incontinence severity were significantly different when compared with before treatment in all three groups (p < 0.05). All three methods were effective in treating symptoms of OAB. However, based on the clinical symptoms, cTTNS is recommended as a preferred and acceptable and safe strategy for the treatment of OAB in women over 50 years old.
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Affiliation(s)
- Hojjat Radinmehr
- Department of Physiotherapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan.
| | - Nahid Radnia
- Hamadan University of Medical Sciences. Fatemie Hospital, Hamadan.
| | - Azade Tabatabaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran.
| | - Mohammad Reza Asadi
- Department of Physiotherapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan.
| | - Soulmaz Rahbar
- Department of Physiotherapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan.
| | - Ailin Talimkhani
- Department of Physiotherapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan.
| | - Amin Doosti Irani
- Department of Epidemiology, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan.
| | - Gholam Reza Hajvalie
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran.
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Correyero-León M, Llamas-Ramos R, Calvo-Rodrigo J, Alvarado-Omenat JJ, Llamas-Ramos I. Transcutaneous Tibial Nerve Stimulation for Primary Dysmenorrhea: A Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11111633. [PMID: 37297773 DOI: 10.3390/healthcare11111633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Primary dysmenorrhea (PD) is a painful menstruation that can persist for the duration of a woman's fertile life. Non-steroidal anti-inflammatory drugs, hormonal therapy, physiotherapy techniques, etc., are the main treatments. The main objective of this study is to evaluate the effectiveness of transcutaneous posterior tibial nerve stimulation (TTNS) in PD patients. The study will consist of a single-blind randomized clinical trial, parallel-assigned with two arms. Women with PD (18-43 years) with regular menstrual cycles and at least 4 points in VAS will be randomly divided into experimental (TTNS) and placebo (simulated stimulation) groups during 12 treatment sessions (1 session/week) and several follow-ups: monthly during treatment and 1, 3 and 6 months after. Maximum and mean pain intensity, pain duration, pain severity, number of anti-inflammatory drugs, quality of life, sleep quality, overall improvement, treatment satisfaction and secondary effects will be measured once a month every 6 months and at 3 and 6 months. The Student's t-test for independent samples or the Mann-Whitney U test will be used. The literature shows effective physiotherapeutic techniques for PD in the short term, which do not act on causes and have limitations. The TTNS technique can be used in transcutaneous and percutaneous modalities, with similar effectiveness, but the transcutaneous causes less discomfort. TTNS modulates pain, and long-term benefits could be achieved at low cost and without patient discomfort.
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Affiliation(s)
| | - Rocío Llamas-Ramos
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Universidad de Salamanca, Avda, Donantes de Sangre s/n, 37007 Salamanca, Spain
| | | | | | - Inés Llamas-Ramos
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Universidad de Salamanca, Avda, Donantes de Sangre s/n, 37007 Salamanca, Spain
- University Hospital of Salamanca, P.° de San Vicente, 182, 37007 Salamanca, Spain
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Cerdán Santacruz C, Cerdán Santacruz DM, Milla Collado L, Ruiz de León A, Cerdán Miguel J. Multimodal Management of Fecal Incontinence Focused on Sphincteroplasty: Long-Term Outcomes from a Single Center Case Series. J Clin Med 2022; 11. [PMID: 35807037 DOI: 10.3390/jcm11133755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023] Open
Abstract
The management of patients with fecal incontinence and an external anal sphincter (EAS) defect remains controversial. A retrospective series of overlapping anal sphincteroplasties performed between 1985−2013 from a single center, supplemented by selective puborectalis plication and internal anal sphincter repair is presented. Patients were clinically followed along with anorectal manometry, continence scoring (Cleveland Clinic Incontinence Score—CCS) and patient satisfaction scales. Patients with a suboptimal outcome were managed with combinations of biofeedback therapy (BFT), peripheral tibial nerve stimulation (PTNS), sacral nerve stimulation (SNS) or repeat sphincteroplasty. There were 120 anterior sphincter repairs with 90 (75%) levatorplasties and 84 (70%) IAS repairs. Over a median follow-up of 120 months (IQR 60−173.7 months) there were significant improvements in the recorded CCIS values (90.8% with a preoperative CCIS > 15 vs. 2.5% postoperatively; p < 0.001). There were 42 patients who required ancillary treatment with four repeat sphincteroplasties, 35 patients undergoing biofeedback therapy, 10 patients treated with PTNS and three managed with SNS implants with an ultimate good functional outcome in 92.9% of cases. No difference was noted in ultimate functional outcome between those treated with sphincteroplasty alone compared with those who needed ancillary treatments (97.1% vs. 85.7%, respectively). Overall, 93.3% considered the outcome as either good or excellent. Long-term functional outcomes of an overlapping sphincteroplasty are good. If the initial outcome is suboptimal, response to ancillary treatments remains good and patients are not compromised by a first-up uncomplicated sphincter repair.
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Zyczynski HM, Richter HE, Sung VW, Lukacz ES, Arya LA, Rahn DD, Visco AG, Mazloomdoost D, Carper B, Gantz MG. Percutaneous Tibial Nerve Stimulation vs Sham Stimulation for Fecal Incontinence in Women: NeurOmodulaTion for Accidental Bowel Leakage Randomized Clinical Trial. Am J Gastroenterol 2022; 117:654-667. [PMID: 35354778 PMCID: PMC8988447 DOI: 10.14309/ajg.0000000000001605] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To determine whether percutaneous tibial nerve stimulation (PTNS) is superior to sham stimulation for the treatment of fecal incontinence (FI) in women refractory to first-line treatments. METHODS Women aged 18 years or older with ≥3 months of moderate-to-severe FI that persisted after a 4-week run-in phase were randomized 2:1 (PTNS:sham stimulation) to 12 weekly 30-minute sessions in this multicenter, single-masked, controlled superiority trial. The primary outcome was change from baseline FI severity measured by St. Mark score after 12 weeks of treatment (range 0-24; minimal important difference, 3-5 points). The secondary outcomes included electronic bowel diary events and quality of life. The groups were compared using an adjusted general linear mixed model. RESULTS Of 199 women who entered the run-in period, 166 (of 170 eligible) were randomized, (111 in PTNS group and 55 in sham group); the mean (SD) age was 63.6 (11.6) years; baseline St. Mark score was 17.4 (2.7); and recording was 6.6 (5.5) FI episodes per week. There was no difference in improvement from baseline in St. Mark scores in the PTNS group when compared with the sham group (-5.3 vs -3.9 points, adjusted difference [95% confidence interval] -1.3 [-2.8 to 0.2]). The groups did not differ in reduction in weekly FI episodes (-2.1 vs -1.9 episodes, adjusted difference [95% confidence interval] -0.26 [-1.85 to 1.33]). Condition-specific quality of life measures did not indicate a benefit of PTNS over sham stimulation. Serious adverse events occurred in 4% of each group. DISCUSSION Although symptom reduction after 12 weeks of PTNS met a threshold of clinical importance, it did not differ from sham stimulation. These data do not support the use of PTNS as conducted for the treatment of FI in women.
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Affiliation(s)
- Halina M. Zyczynski
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh/ Magee-Womens Research Institute, Pittsburgh, PA
| | - Holly E. Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Vivian W. Sung
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women’s & Infants Hospital, Providence, RI
| | - Emily S. Lukacz
- Department of Obstetrics, Gynecology & Reproductive Sciences, UC San Diego Health, San Diego, CA
| | - Lily A. Arya
- Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, PA
| | - David D. Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Anthony G. Visco
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Benjamin Carper
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, United States
| | - Marie G. Gantz
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, United States
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Song J, Cao X, Zhang A, Fang Z, Xu J, Gao X. Posterior tibial nerve stimulation improves neurogenic bladder in rats with spinal cord injury through transient receptor potential/P2X signaling pathway. Neurourol Urodyn 2022; 41:756-764. [PMID: 35132690 DOI: 10.1002/nau.24885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/24/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND To study the influences of posterior tibial nerve stimulation (PTNS) on neurogenic bladder and the expression of transient receptor potential (TRP) channels and P2X receptors in rats with spinal cord injury (SCI) and explore the possible mechanism. METHODS SCI model was established by modified Allen's method and PTNS was performed. Urodynamic indexes and Haematoxylin and Eosine staining of bladder tissue were used to evaluate the therapeutic effect. The expression of TRP channels and P2X receptors in the bladder and dorsal root ganglia (DRG) was detected by real-time PCR and Western blot. RESULTS The low compliance of bladder in treatment group was significantly improved compared with SCI group, and the infiltration of inflammatory cells in bladder tissue was significantly reduced. At the same time, the expression of TRP and P2X in bladder and DRG was partially restored after the treatment of PTNS. CONCLUSIONS PTNS is an effective therapy for SCI-induced neurogenic bladder via the TRP/P2X signaling pathway.
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Affiliation(s)
- Juan Song
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoyu Cao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Akang Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zheng Fang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiegou Xu
- Department of Immunology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Xiaoping Gao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Scarneciu I, Lupu S, Bratu OG, Teodorescu A, Maxim LS, Brinza A, Laculiceanu AG, Rotaru RM, Lupu AM, Scarneciu CC. Overactive bladder: A review and update. Exp Ther Med 2021; 22:1444. [PMID: 34721686 DOI: 10.3892/etm.2021.10879] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022] Open
Abstract
Overactive bladder syndrome is a chronic, disabling condition with physical, psychological and social consequences that significantly affects the quality of life of millions of patients worldwide. The economic impact of this disorder is crucial. Overactive bladder syndrome is a little-known condition, with different manifestations from patient to patient, which causes a great deal of frustration to the medical staff involved. The patient requires a clear explanation and the full support of the attending physician. It is extremely important to establish a correct diagnosis and an effective individualized treatment. The collaboration and understanding of these patients are extremely important aspects. Improving the quality of life in these patients is the main purpose in managing this condition. There are several treatment modalities that may be used progressively, with favorable albeit inconsistent results. This condition remains extremely challenging for specialists and, unfortunately, always one of maximum interest.
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Affiliation(s)
- Ioan Scarneciu
- Department of Medical and Surgical Specialities, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
| | - Sorin Lupu
- Clinic of Urology, Brasov Emergency Clinical County Hospital, 500326 Brasov, Romania
| | - Ovidiu Gabriel Bratu
- Clinical Department 3, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Teodorescu
- Department of Fundamental, Prophylactic and Clinical Disciplines, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
| | - Laurian Stefan Maxim
- Department of Medical and Surgical Specialities, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
| | - Adrian Brinza
- Department of Medical and Surgical Specialities, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
| | - Alexandru Georgian Laculiceanu
- Department of Fundamental, Prophylactic and Clinical Disciplines, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
| | - Ruxandra Maria Rotaru
- Department of Medical and Surgical Specialities, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
| | - Aura-Mihaela Lupu
- Department of Radiology, Brasov CF General Hospital, 500097 Brasov, Romania
| | - Camelia Cornelia Scarneciu
- Department of Fundamental, Prophylactic and Clinical Disciplines, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
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Kabay S, Kabay SC, Sevim M. First-line treatment posterior tibial nerve stimulation in patients with interstitial cystitis/bladder pain syndrome. Cent European J Urol 2021; 74:208-214. [PMID: 34336240 PMCID: PMC8318015 DOI: 10.5173/ceju.2021.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to determine the effects of first-line treatment posterior tibial nerve stimulation (PTNS), applied once a week for a 12 week period, as a treatment modality for patients with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Material and methods A total of 39 female patients with IC/BPS were enrolled in the study. Patients had one 30-minute session of PTNS per week for 12 weeks and symptoms were assessed before and after the treatment sessions by the use of a voiding diary, visual analog scale (VAS) for pain, O'Leary-Sant interstitial cystitis symptom index (ICSI), and O'Leary-Sant interstitial cystitis problem index (ICPI). Results The mean age of the patients was 38.9 ±7.1 years. The improvements in voiding diary parameters after 12 weeks of PTNS treatment were statistically significant compared to baseline but the changes in nocturia, and average voiding volume were not statistically significant. Mean parametric improvements after 12 weeks of PTNS treatment compared to baseline included a daytime frequency decrease by 3.8 voids daily, urgency episodes decrease by 4.7 episodes daily, nocturia decrease by 0.3 voids and voided volume improvement by a mean of 8.4 ml. The difference for ICSI, ICPI and VAS between baseline and the 12th week of PTNS treatment scores demonstrated statistically significant improvements in pain severity, symptom and problem index. Conclusions The findings in this study demonstrated the improvements of voiding diaries, ICSI, ICPI and VAS scores in patients with IC/BPS after 12 weeks PTNS. PTNS treatment is a beneficial firs-line treatment option to IC/BPS symptom amelioration.
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Affiliation(s)
- Sahin Kabay
- Altinbas University Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - Sibel Canbaz Kabay
- Kutahya Health Sciences University, Faculty of Medicine, Department of Neurology, Kutahya, Turkey
| | - Mehmet Sevim
- Kutahya Health Sciences University, Faculty of Medicine, Department of Urology, Kutahya, Turkey
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12
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Sanagapalli S, Neilan L, Lo JYT, Anandan L, Liwanag J, Raeburn A, Athanasakos E, Zarate-Lopez N, Emmanuel A. Efficacy of Percutaneous Posterior Tibial Nerve Stimulation for the Management of Fecal Incontinence in Multiple Sclerosis: A Pilot Study. Neuromodulation 2018; 21:682-687. [PMID: 29575432 DOI: 10.1111/ner.12764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/09/2017] [Accepted: 01/04/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fecal incontinence is a debilitating and highly prevalent problem among multiple sclerosis patients. Conservative therapies often fail to provide benefit. Posterior tibial nerve stimulation is a minimally invasive neuromodulatory therapy with proven efficacy for fecal incontinence in non-neurological settings. OBJECTIVE To evaluate the efficacy of posterior tibial nerve stimulation in treating multiple sclerosis-related fecal incontinence. METHODS Consecutive multiple sclerosis patients with fecal incontinence that had failed conservative therapy received posterior tibial nerve stimulation between 2012 and 2015. All patients had previously undergone anorectal physiology tests and endoanal ultrasound. Patients whose Wexner incontinence score reduced below 10 post-therapy or halved from baseline were deemed responders. RESULTS Thirty-three patients (25 female, median age 43 years) were included. Twenty-three (70%) had urge, 4 (12%) passive, and 9 (27%) mixed fecal incontinence. Twenty-six (79%) were classified as responders. The majority of subjects had relapsing-remitting multiple sclerosis (67%); those had a significantly higher response rate (95% vs. 67% and 50% in primary and secondary progressive respectively, P < 0.05). Responders tended to be more symptomatic at baseline and had greater improvements in bowel symptom scores and quality of life scores with therapy. CONCLUSION Posterior tibial nerve stimulation demonstrates potential as an effective therapy for fecal incontinence in multiple sclerosis. These findings provide the basis for future more definitive controlled studies.
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Affiliation(s)
| | - Laura Neilan
- School of Medicine, Royal College of Surgeons of Ireland, Dublin, Ireland
| | | | | | - Jorge Liwanag
- GI Physiology Unit, University College London Hospital, London, UK
| | - Amanda Raeburn
- GI Physiology Unit, University College London Hospital, London, UK
| | | | | | - Anton Emmanuel
- GI Physiology Unit, University College London Hospital, London, UK.,School of Medicine, University College London, London, UK
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13
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Dabby R, Sadeh M, Goldberg I, Finkelshtein V. Electrical stimulation of the posterior tibial nerve reduces neuropathic pain in patients with polyneuropathy. J Pain Res 2017; 10:2717-2723. [PMID: 29238215 PMCID: PMC5716322 DOI: 10.2147/jpr.s137420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Peripheral neuropathic pain (PNP) is caused by neuronal damage to the peripheral nervous system and usually affects the distal extremities. This open-label study examined the effect of short-term peripheral nerve stimulation (PNS) on individuals with PNP due to polyneuropathy. A total of 12 patients (mean age, 63.0 ± 10.0 years, 41.7% male) with daily bilateral PNP for at least 6 months (mean duration, 7.4 ± 7.8 years) received a total of six direct electrical stimulation therapies to the posterior tibial nerve at 3-4-day intervals. Eight patients completed the study and were included in the efficacy analysis. The average pain at baseline was 36.6 ± 3.80 estimated by the Short-Form McGill Pain Questionnaire. After the last stimulation, pain was significantly reduced by 85.5% to 4.88 ± 3.1 (p = 0.008). Six patients (75%) had over 50% decrease in pain after the first stimulation therapy and 99.2% after the final stimulation therapy. The patients also reported statistically significant decreases in pain level (measured by visual analog scale), ranging from 54.85% to 87.50% after each of the stimulations as compared to the pain experienced prior to the stimulations. The procedure was safe without any serious adverse events. PNS has demonstrated excellent efficacy and improvement of PNP symptoms. Further studies in larger patient populations are warranted.
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Affiliation(s)
- Ron Dabby
- Department of Neurology, Wolfson Medical Center, Holon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menachem Sadeh
- Department of Neurology, Wolfson Medical Center, Holon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldberg
- Department of Neurology, Wolfson Medical Center, Holon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vitaly Finkelshtein
- Department of Neurology, Wolfson Medical Center, Holon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Altomare DF, Picciariello A, Ferrara C, Digennaro R, Ribas Y, De Fazio M. Short-term outcome of percutaneous tibial nerve stimulation for low anterior resection syndrome: results of a pilot study. Colorectal Dis 2017; 19:851-856. [PMID: 28371160 DOI: 10.1111/codi.13669] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/17/2017] [Indexed: 12/13/2022]
Abstract
AIM Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive procedure which has been demonstrated to be effective in faecal/urinary incontinence but has never been tested in low anterior resection syndrome (LARS). The severity of LARS may be evaluated by the LARS score, but rectal cancer treatments may also affect urinary and sexual function, which are not explored by the LARS score. The Three Axial Perineal Evaluation (TAPE) score is a new validated index addressing the overall pelvic floor functions. This study aims to assess the efficacy of PTNS in LARS patients and to evaluate the results by the LARS and TAPE scores. METHODS Twenty-one patients operated on for rectal cancer between 2009 and 2014 complaining of LARS underwent PTNS (12 sessions of 30 min each). Six patients reported urinary incontinence and all except two (men) were sexually inactive. The LARS score and the TAPE score questionnaires were administered at baseline and after 6 months of follow-up. RESULTS At 6 months' follow-up, nine patients reported a significant improvement of faecal incontinence and 3/6 an improvement of urinary incontinence after PTNS. Median LARS score significantly decreased from 32 to 27 (P = 0.009), while the median TAPE score improved significantly from 55 to 58 (P = 0.004). CONCLUSIONS PTNS may be a further option in the treatment of selected patients with LARS and in addition may improve associated urinary incontinence. The severity of LARS can be detected by the LARS score; however, the adoption of the TAPE score is preferred in the case of concomitant urinary and/or sexual problems not explored by the LARS score.
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Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
| | - A Picciariello
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
| | - C Ferrara
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
| | - R Digennaro
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
| | - Y Ribas
- Department of Surgery, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain
| | - M De Fazio
- Department of Emergency and Organ Transplantation and Inter-department Research Center for Pelvic Floor Diseases (CIRPAP), University 'Aldo Moro' of Bari, Bari, Italy
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15
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Kumar L, Liwanag J, Athanasakos E, Raeburn A, Zarate-Lopez N, Emmanuel AV. Effectiveness of percutaneous tibial nerve stimulation in managing refractory constipation. Colorectal Dis 2017; 19:45-49. [PMID: 27197580 DOI: 10.1111/codi.13388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/14/2016] [Indexed: 02/08/2023]
Abstract
AIM Chronic constipation can be aetiopathogenically classified into slow transit constipation (STC), rectal evacuation difficulty (RED) or a combination (BOTH). Although the efficacy of percutaneous tibial nerve stimulation (PTNS) in faecal incontinence has been well proved, a current literature search identifies only one study which assessed its effect on constipation. We aimed to evaluate the effectiveness of PTNS in patients with different causes of constipation. METHOD Thirty-four patients [30 women, median age 50 (20-79) years] with constipation who had previously failed maximal laxative and biofeedback therapy participated in the study. All patients underwent a baseline radio-opaque marker transit study and anorectal physiology examination. All had 12 sessions of PTNS of 30 min per session. A fall in the Wexner constipation score to ≤15 or by ≥5 points was taken as the primary outcome. Secondary outcomes included the results of pre- and post- PTNS transit and anorectal physiology studies. RESULTS Eleven patients had STC, 14 had RED and nine had BOTH. A response was seen in four patients (1/11 STC, 2/14 RED and 1/9 BOTH). Comparing pre- and post- PTNS, there was no significant change in the mean Wexner score (P = 0.10). There was no change in colonic transit time among the whole population (P = 0.56) or among those with STC (P = 0.47). There was no improvement in balloon expulsion in the whole group (P = 0.73) or in patients with RED (P = 0.69). CONCLUSION PTNS is of no benefit to patients with constipation, whatever aetiopathogenic mechanism is responsible for the symptoms.
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Affiliation(s)
- L Kumar
- GI Physiology Unit, University College Hospital, London, UK.,Division of Medicine, University College London, London, UK
| | - J Liwanag
- GI Physiology Unit, University College Hospital, London, UK
| | - E Athanasakos
- GI Physiology Unit, University College Hospital, London, UK
| | - A Raeburn
- GI Physiology Unit, University College Hospital, London, UK
| | - N Zarate-Lopez
- GI Physiology Unit, University College Hospital, London, UK
| | - A V Emmanuel
- GI Physiology Unit, University College Hospital, London, UK.,Division of Medicine, University College London, London, UK
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16
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Al Asari S, Meurette G, Mantoo S, Kubis C, Wyart V, Lehur PA. Percutaneous tibial nerve stimulation vs sacral nerve stimulation for faecal incontinence: a comparative case-matched study. Colorectal Dis 2014; 16:O393-9. [PMID: 24911219 DOI: 10.1111/codi.12680] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/10/2014] [Indexed: 12/13/2022]
Abstract
AIM The study assessed the initial experience with posterior tibial nerve stimulation (PTNS) for faecal incontinence and compared it with sacral nerve stimulation (SNS) performed in a single centre during the same timespan. METHOD A retrospective review of a prospectively collected database was conducted at the colorectal unit, University Hospital, Nantes, France, from May 2009 to December 2010. Seventy-eight patients diagnosed with chronic severe faecal incontinence underwent neurostimulation including PTNS in 21 and SNS in 57. The main outcome measures were faecal incontinence (Wexner score) and quality of life (Fecal Incontinence Quality of Life, FIQL) scores in a short-term follow-up. RESULTS No significant differences were observed in patients' characteristics. Of 57 patients having SNS, 18 (32%) failed peripheral nerve evaluation and 39 (68%) received a permanent implant. Two (5%) developed a wound infection. No adverse effects were recorded in the PTNS group. There was no significant difference in the mean Wexner and FIQL scores between patients having PTNS and SNS at 6 (P = 0.39 and 0.09) and 12 months (P = 0.79 and 0.37). A 50% or more improvement in Wexner score was seen at 6 and 12 months in 47% and 30% of PTNS patients and in 50% and 58% of SNS patients with no significant difference between the groups. CONCLUSION Posterior tibial nerve stimulation is a valid method of treating faecal incontinence in the short term when conservative treatment has failed. It is easier, simpler, cheaper and less invasive than SNS with a similar short-term outcome.
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Affiliation(s)
- S Al Asari
- Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif (IMAD), University Hospital of Nantes, Nantes, France
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Abstract
Fecal incontinence (FI) is a devastating condition affecting a substantial portion of the population. The etiologies of FI are wide ranging, as are the treatment options. When conservative measures fail, often surgical intervention is required. As in any area where a wide range of treatment options exist, there is no one perfect solution. Fortunately, novel treatment options for FI are becoming available, namely, posterior tibial nerve stimulation, magnetic anal sphincter, stem cell transplant, pyloric transplantation, and acupuncture.
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Affiliation(s)
- Adam Barker
- Department of Colon and Rectal Surgery, Presbyterian Hospital, Dallas, Texas
| | - Jefferson Hurley
- Department of Colon and Rectal Surgery, Presbyterian Hospital, Dallas, Texas
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18
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Zbar AP. Sacral neuromodulation and peripheral nerve stimulation in patients with anal incontinence: an overview of techniques, complications and troubleshooting. Gastroenterol Rep (Oxf) 2014; 2:112-20. [PMID: 24759349 PMCID: PMC4020133 DOI: 10.1093/gastro/gou015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sacral neuromodulation (SNM) therapy has revolutionized the management of many forms of anal incontinence, with an expanded use and a medium-term efficacy of 75% overall. This review discusses the technique of SNM therapy, along with its complications and troubleshooting and a discussion of the early data pertaining to peripheral posterior tibial nerve stimulation in incontinent patients. Future work needs to define the predictive factors for neurostimulatory success, along with the likely mechanisms of action of their therapeutic action.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel and Assia Medical Colorectal Group Assuta Private Hospital, Tel Aviv, Israel
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19
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Barroso U, Viterbo W, Bittencourt J, Farias T, Lordêlo P. Posterior tibial nerve stimulation vs parasacral transcutaneous neuromodulation for overactive bladder in children. J Urol 2013; 190:673-7. [PMID: 23422257 DOI: 10.1016/j.juro.2013.02.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE Parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation have emerged as effective methods to treat overactive bladder in children. However, to our knowledge no study has compared the 2 methods. We evaluated the results of parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation in children with overactive bladder. MATERIALS AND METHODS We prospectively studied children with overactive bladder without dysfunctional voiding. Success of treatment was evaluated by visual analogue scale and dysfunctional voiding symptom score, and by level of improvement of each specific symptom. Parasacral transcutaneous electrical nerve stimulation was performed 3 times weekly and posterior tibial nerve stimulation was performed once weekly. RESULTS A total of 22 consecutive patients were treated with posterior tibial nerve stimulation and 37 with parasacral transcutaneous electrical nerve stimulation. There was no difference between the 2 groups regarding demographic characteristics or types of symptoms. Concerning the evaluation by visual analogue scale, complete resolution of symptoms was seen in 70% of the group undergoing parasacral transcutaneous electrical nerve stimulation and in 9% of the group undergoing posterior tibial nerve stimulation (p = 0.02). When the groups were compared, there was no statistically significant difference (p = 0.55). The frequency of persistence of urgency and diurnal urinary incontinence was nearly double in the group undergoing posterior tibial nerve stimulation. However, this difference was not statistically significant. CONCLUSIONS We found that parasacral transcutaneous electrical nerve stimulation is more effective in resolving overactive bladder symptoms, which matches parental perception. However, there were no statistically significant differences in the evaluation by dysfunctional voiding symptom score, or in complete resolution of urgency or diurnal incontinence.
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Affiliation(s)
- Ubirajara Barroso
- Center for Voiding Disorders in Children (CEDIMI), Section of Pediatric Urology, Division of Urology, Bahiana School of Medicine, Salvador, Bahia, Brazil
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20
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Tirlapur SA, Vlismas A, Ball E, Khan KS. Nerve stimulation for chronic pelvic pain and bladder pain syndrome: a systematic review. Acta Obstet Gynecol Scand 2013; 92:881-7. [PMID: 23710833 DOI: 10.1111/aogs.12184] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/19/2013] [Indexed: 01/14/2023]
Abstract
Chronic pelvic pain (CPP) and bladder pain syndrome (BPS) can have a negative impact on quality of life. Neuromodulation has been suggested as a possible treatment for refractory pain. To assess the effectiveness of tibial and sacral nerve stimulation in the treatment of BPS and CPP. We searched until July 2012: the Cochrane Library, EMBASE (1980-2012), Medline (1950-2012), Web of knowledge (1900-2012), LILACS (1982-2012) and SIGLE (1990-2012) with no language restrictions. We manually searched through bibliographies and conference proceedings of the International Continence Society. Randomized and prospective quasi-randomized controlled studies vs. sham nerve stimulation treatment or usual care of patients with CPP and BPS who underwent sacral or tibial nerve stimulation were included. Any studies involving transcutaneous stimulation were excluded. The outcome was a cure or improvement in symptoms. Three studies with 169 patients treated with tibial nerve stimulation were included; two for CPP and one for BPS. There were improvements in pain, urinary and quality of life scores. There were no reported data for sacral nerve stimulation. There is scanty literature reporting variable success of posterior tibial nerve stimulation in improving pain, urinary symptoms and quality of life in CPP and BPS. In view of the dearth of quality literature, a large multi-centered clinical trial investigating the effectiveness of electrical nerve stimulation to treat BPS and CPP along with the cost-analysis of this treatment is recommended.
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Affiliation(s)
- Seema A Tirlapur
- Women's Health Research Unit, Queen Mary, University of London, London, UK.
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21
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Abstract
From the time that it was granted US Food and Drug Administration approval, neuromodulation has secured a firm position in the treatment algorithm for overactive bladder. With neuromodulation, physicians were able to bridge the gap between the two ends of the treatment spectrum (medical therapy and open surgery). Sacral nerve stimulation has been the most widely used form of neuromodulation. Recent modifications to its design, namely the development of the tined lead and the launching of the refined InterStim II (Medtronic, Minneapolis, MN), have made sacral nerve simulation even less invasive and more effective. While InterStim is maintaining a level of success with these advancements, peripheral means of neuromodulation are being explored. The current literature takes a closer look at posterior tibial and pudendal nerve stimulation as alternatives to sacral nerve stimulation. The field of neuromodulation is also expanding in terms of the target patient population, as it is being used to treat children, patients with neurological disease, and others. As the role of neuromodulation increases, we must continue to assess its efficacy, safety, and cost-effectiveness in comparison to other therapeutic options.
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Affiliation(s)
- Ngoc-Bich Le
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Frank Clark Urology Center, 200 Medical Plaza, Suite 140, Los Angeles, CA 90025 USA
| | - Ja-Hong Kim
- Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Frank Clark Urology Center, 200 Medical Plaza, Suite 140, Los Angeles, CA 90025 USA
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