Neuromodulation for Lower Urinary Tract Dysfunction – An Update

Abstract

The aim of this review is to provide an update on the use of neuromodulation using sacral nerve stimulation for the treatment of disorders of the lower urinary tract. Neuromodulation using the InterStim® system (Medtronic Inc.) is now accepted as an established therapeutic option for patients with detrusor overactivity, and for women with retention or severe voiding difficulties. However, the use of nerve stimulation in modulating lower urinary tract function has to be regarded as a technique that is in its infancy. Much has yet to be learned about the mechanism by which neuromodulation exerts its effects and there is a need to better define the clinical indications for the treatment. There is also work to be done in terms of optimising stimulation delivery, both in anatomical and electronic terms.

Comparison of neural targets for neuromodulation of bladder micturition reflex in the rat

“…Clinically, percutaneous stimulation of the TN uses a 30-min stimulation once per week for 12 consecutive wk for office-based treatment of overactive bladder symptoms (34) and SN stimulation uses continuous stimulation with an implanted stimulator/electrode (9). Since SN and TN stimulation have not been administered clinically using a similar treatment protocol, it is not known whether the two stimulation sites will produce a similar degree of poststimulation inhibition of bladder activity in patients with hyperactive bladder.…”

Optimization of Neuromodulation for Bladder Control in a Rat Cystitis Model

“…InterStim ® Therapy (Medtronic, Inc., Minneapolis, MN, USA), utilizing the electrical stimulation of the sacral spinal nerve, has been successful in the treatment for patients with increased frequency and urge incontinence (1,2). The optimal stimulation parameters (current intensity and frequency) of neuromodulation have been identified for spinal nerve stimulation (SNS)-induced inhibition of bladder contractions in the rat under isovolumetric conditions (3,4).…”

Quantification of effectiveness of bilateral and unilateral neuromodulation in the rat bladder rhythmic contraction model

“…InterStim® Therapy, utilizing electrical stimulation of the sacral spinal nerve (SN, S3), is an established treatment for patients with overactive bladder [1]. The classical unilateral stimulation technique uses an electrode implanted in the S3 foramen and connected to an implanted pulse generator [2,3].…”