Current and future techniques of neuromodulation for bladder dysfunction

Abstract

Recent increase in the use of neuromodulation for the treatment of urinary urgency and frequency, urge incontinence, and nonobstructive urinary retention has coincided with improved knowledge of micturition physiology and concurrent technologic advances in nerve stimulation. Currently, the most common technology for bladder neuromodulation involves stimulation through the S3 foramen, or sacral neuromodulation, although other techniques of neuromodulation continue to be explored. Despite many advances in neuromodulation, the exact mechanism of action remains uncertain. Additionally, which patients will respond to neuromodulation remains unclear, and although there is a standard method for testing, this procedure is invasive and expensive. As we continue to improve patient selection criteria and better understand the mechanism of action, the efficacy and patient satisfaction should continue to increase. Currently, most patients considered for implantation with a neuromodulator are those unresponsive to other conservative treatments for bladder dysfunction.

Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease

“…5,11 Sacral neuromodulation with surgical implantation of an S3 stimulator was proposed to treat refractory urge incontinence due to DO. 12,13 However, previous studies with chronic stimulation of the posterior tibial nerve have been used to evaluate the effect of stimulation. 14 -16 Urodynamic data on the efficacy of chronic posterior tibial nerve stimulation (PTNS) with various different electrostimulation techniques in DO are available in previous study.…”

A spinal GABAergic mechanism is necessary for bladder inhibition by pudendal afferent stimulation

“…In particular, pudendal afferent stimulation inhibits distension-evoked bladder contractions and improves continence (51). We sought to identify the mechanism(s) of bladder inhibition by pudendal afferent stimulation.Pudendal nerve (PN) stimulation may be an alternative to sacral nerve stimulation to improve continence (33), and in patients who do not respond to sacral neuromodulation it may be a successful treatment option (29,34,41). Low-frequency (ϳ10 Hz) pudendal afferent stimulation inhibits bladder contractions, thereby promoting continence in preclinical animal studies (4, 46, 52).…”

Electrical stimulation for the treatment of lower urinary tract dysfunction after spinal cord injury

“…92 PNS may be an alternative neuromodulation therapy for refractory OAB, particularly in patients who do not respond well to SNS. [93][94][95] However, although a CE mark has been granted in Europe, PNS remains for investigational use only in the United States. Studies are ongoing to evaluate the effectiveness of PNS for bladder control following SCI and to study novel stimulation paradigms for more effective treatment of NLUTD.…”