Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives

Abstract

ObjectivesThis review describes the evidence from established and experimental therapies that use electrical nerve stimulation to treat lower urinary tract dysfunction.MethodsClinical studies on established treatments such as percutaneous posterior tibial nerve stimulation (P-PTNS), transcutaneous electrical nerve stimulation (TENS), sacral nerve stimulation (SNS) and sacral anterior root stimulation (SARS) are evaluated. In addition, clinical evidence from experimental therapies such as dorsal genital nerve (DGN) stimulation, pudendal nerve stimulation, magnetic nerve stimulation and ankle implants for tibial nerve stimulation are evaluated.ResultsSNS and P-PTNS have been investigated with high-quality studies that have shown proven efficacy for the treatment for overactive bladder (OAB). SARS has proven evidence-based efficacy in spinal cord patients and increases the quality of life. TENS seems inferior to other OAB treatments such as SNS and P-PTNS but is noninvasive and applicable for ambulant therapy. Results from studies on experimental therapies such as pudendal nerve stimulation seem promising but need larger study cohorts to prove efficacy.ConclusionNeurostimulation therapies have proven efficacy for bladder dysfunction in patients who are refractory to other therapies.SignificanceRefinement of neurostimulation therapies is possible. The aim should be to make the treatments less invasive, more durable and more effective for the treatment of lower urinary tract dysfunction.

Suppression of Urinary Voiding by Conditional High Frequency Stimulation of the Pelvic Nerve in Conscious Rats

“…Neuromodulatory approaches have great potential for treating dysfunctional control of the urinary bladder, in particular urge urinary incontinence (UUI) where sufferers experience a “sudden and overwhelming desire to void, which is difficult to defer” ( Abrams et al, 2003 ). In the clinical setting, sacral nerve stimulation is the procedure offered most commonly in cases that are refractory to current pharmacological and chemodenervation approaches, although other targets are also being used (see Janssen et al, 2017 for a recent review). In animal studies the net has been cast wider and there are several indications from studies in anesthetized cats and rats that stimulation of the tibial, saphenous, pudendal, dorsal penile, dorsal clitoral, and pelvic nerves all have the potential to modulate voiding ( Snellings and Grill, 2012 ; Su et al, 2012a , b ; Kovacevic and Yoo, 2014 ; Jen et al, 2016 ; Langdale et al, 2017 ; Moazzam and Yoo, 2017 ; Uy et al, 2017 ).…”

Neural Prosthetics:A Review of Empirical vs. Systems Engineering Strategies

“…It is particularly common in young women and is associated with bladder infections that leave scarred and hypersensitive bladder walls. It can be treated by taking advantage of an inhibitory reflex from the cutaneous receptors in the clitoris or penis that is designed to prevent urine leakage during sexual activity, so stimulation must be applied continuously except when micturition is desired [ 84 ]. A surgically implanted stimulator targets these sensory afferents in the spinal nerves as they exit the sacrum ( Figure 1 ).…”

“…A percutaneously implantable microstimulator with a small rechargeable lithium cell can target the same sensory nerve fibers in the pudendal nerve in the pelvis, but there were problems with implanting and maintaining them at the correct location, and the tiny lithium cell must be recharged via an external coil every few days [ 86 ]. Some success has been reported for stimulation of low-threshold mechanoreceptors in the leg using either implanted or transcutaneous stimulators [ 84 ], probably because of segmental inhibitory circuits similar to the gate theory for pain modulation Overflow incontinence arises because the patient cannot switch the urinary tract out of its normal state of maintaining continence by reflexive closure of the sphincter when a bladder contraction occurs; the bladder fills and pressure increases until urine leaks past the closed sphincter. It is particularly common after spinal cord injury and some neural degenerative diseases that interrupt the ability to sense bladder fullness and/or generate the descending command from the brain that inhibits the sphincter reflex.…”

“…A percutaneously implantable microstimulator with a small rechargeable lithium cell can target the same sensory nerve fibers in the pudendal nerve in the pelvis, but there were problems with implanting and maintaining them at the correct location, and the tiny lithium cell must be recharged via an external coil every few days [ 86 ]. Some success has been reported for stimulation of low-threshold mechanoreceptors in the leg using either implanted or transcutaneous stimulators [ 84 ], probably because of segmental inhibitory circuits similar to the gate theory for pain modulation…”

Neuromodulacija kao izbor liječenja kod djeteta s neurogenim mokraćnim mjehurom – prikaz slučaja

“…Kliničke studije pokazuju uspješnost PTNS-a i sakralne NMD u liječenju prekomjerno aktivnoga mokraćnog mjehura, dok je intravezikalna elektrostimulacija uspješnija kod pacijenata sa spinalnim ozljedama kralježnice 5 .…”