Neuromodulation for overactive bladder

Bartley, Jamie; Gilleran, Jason; Peters, Kenneth M.

doi:10.1038/nrurol.2013.143

Cited by 71 publications

(49 citation statements)

References 77 publications

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“…This will be directly evaluated in future experiments by testing TNS during voiding CMGs. The selective action of TNS on bladder capacity in anesthetized cats is similar to the clinical observations in OAB patients that different types of neuromodulation improve urine storage without reducing voiding efficiency (3,11,16,30). This selectivity suggests that neuromodulation targets the afferent limb of the micturition reflex or the supraspinal switching mechanism in the PAG-PMC circuitry but does not alter the efferent (motor) limb of the circuit.…”

Section: Discussionsupporting

confidence: 73%

Role of the brain stem in tibial inhibition of the micturition reflex in cats

Ferroni

Slater

Shen

et al. 2015

American Journal of Physiology-Renal Physiology

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This study examined the role of the brain stem in inhibition of bladder reflexes induced by tibial nerve stimulation (TNS) in ␣-chloralose-anesthetized decerebrate cats. Repeated cystometrograms (CMGs) were performed by infusing saline or 0.25% acetic acid (AA) to elicit normal or overactive bladder reflexes, respectively. TNS (5 or 30 Hz) at three times the threshold (3T) intensity for inducing toe movement was applied for 30 min between CMGs to induce post-TNS inhibition or applied during the CMGs to induce acute TNS inhibition. Inhibition was evident as an increase in bladder capacity without a change in amplitude of bladder contractions. TNS applied for 30 min between saline CMGs elicited prolonged (Ͼ2 h) poststimulation inhibition that significantly (P Ͻ 0.05) increased bladder capacity to 30 -60% above control; however, TNS did not produce this effect during AA irritation. TNS applied during CMGs at 5 Hz but not 30 Hz significantly (P Ͻ 0.01) increased bladder capacity to 127.3 Ϯ 6.1% of saline control or 187.6 Ϯ 5.0% of AA control. During AA irritation, naloxone (an opioid receptor antagonist) administered intravenously (1 mg/kg) or directly to the surface of the rostral brain stem (300 -900 g) eliminated acute TNS inhibition and significantly (P Ͻ 0.05) reduced bladder capacity to 62.8 Ϯ 22.6% (intravenously) or 47.6 Ϯ 25.5% (brain stem application). Results of this and previous studies indicate 1) forebrain circuitry rostral to the pons is not essential for TNS inhibition; and 2) opioid receptors in the brain stem have a critical role in TNS inhibition of overactive bladder reflexes but are not involved in inhibition of normal bladder reflexes. neuromodulation; brain stem; opioid; tibial; cat TIBIAL NEUROMODULATION, a Food and Drug Administration (FDA)-approved therapy for overactive bladder (OAB) symptoms, including urgency, frequency, and incontinence (7,19,20,29), is often used to treat patients whose symptoms are not completely controlled by drugs or who have unacceptable drug side effects (1,2,8,18). However, the mechanisms underlying tibial neuromodulation therapy are uncertain. Understanding the site of action and neurotransmitters involved in the inhibition of bladder reflexes by tibial nerve stimulation (TNS) is important for developing new OAB treatments by combining drug therapies with tibial neuromodulation to achieve a higher efficacy with fewer side effects (14,33).Previous studies in cats have demonstrated the inhibitory effect of TNS on bladder reflexes elicited during non-nociceptive saline distention as well as nociceptive acetic acid (AA) irritation (23,27). The failure of TNS to inhibit reflex bladder contractions during AA irritation in animals with acute spinal cord transection at the T9/T10 level (32) indicates that supraspinal neural circuits are necessary for TNS inhibition. However, it is unknown whether these supraspinal circuits are located in the forebrain or in the brain stem.A major clinical benefit of TNS is the long-lasting poststimulation inhibitory effect, which allows...

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Section: Discussionsupporting

confidence: 73%

Role of the brain stem in tibial inhibition of the micturition reflex in cats

Ferroni

Slater

Shen

et al. 2015

American Journal of Physiology-Renal Physiology

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“…6 Several sites have been widely used to treat urinary disorders for neuromodulation including the sacral, pudendal, tibial and genital nerves, but the most widely reported area for the treatment of overactive bladder has been the third sacral nerve root (S3). 7 Percutaneous posterior tibial nerve stimulation (PTNS) is a minimally invasive neuromodulation technique that has been shown to be an effective treatment for patients with neurogenic and non-neurogenic LUTS unresponsive to medical treatment. 8 The efficacy of 12 weeks PTNS treatment to improve idiopathic overactive bladder (OAB) symptoms has been established through randomized, controlled trials, with long-term durability and sustained therapeutic effects during 12 and 24 months.…”

Section: 5 Lutsmentioning

confidence: 99%

The Clinical and Urodynamic Results of Percutaneous Posterior Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Patients With Parkinson's Disease

Kabay

Çetiner

et al. 2016

Urology

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“…However, the most commonly described site of neuromodulation for treatment of OAB is the third sacral nerve root (S3). In addition, this location has the largest amount of long-term data on safety and efficacy 15. There has also been comparison of unilateral lead placement and bilateral lead placement.…”

Section: Pathophysiology/mechanismmentioning

confidence: 99%

Sacral neuromodulation in overactive bladder: a review and current perspectives

Sukhu¹,

Kennelly²,

Kurpad³

2016

RRU

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Overactive bladder (OAB) symptoms of urgency, frequency, and urge incontinence currently affect a substantial portion of the population, especially as age increases. Sacral neuromodulation has become a popular option for refractory OAB symptoms over the past 2 decades. Studies have demonstrated that it is an effective treatment for OAB and urge incontinence as indicated by decreased number of voids, increased bladder capacity, and fewer leakage events. In addition, the effects have proved to be durable to multiple years following implantation. These benefits come at the expense of a high rate of adverse events, although with comparable long-term cost-effectiveness to botulinum toxin A. We aimed to review the literature that demonstrates that sacral neuromodulation continues to be an efficacious treatment for refractory OAB wet and dry patients, with continuously expanding indications.

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Neuromodulation for overactive bladder

Cited by 71 publications

References 77 publications

Role of the brain stem in tibial inhibition of the micturition reflex in cats

Role of the brain stem in tibial inhibition of the micturition reflex in cats

The Clinical and Urodynamic Results of Percutaneous Posterior Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Patients With Parkinson's Disease

Sacral neuromodulation in overactive bladder: a review and current perspectives

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