Neuromodulation in the Treatment of Overactive Bladder With a Focus on Interferential Therapy

Abstract

The application of various forms of neuromodulation has become more common and has been reported to be effective for stress and urgency urinary incontinence. In clinical practice, external (vaginal, anal, and surface electrodes) and internal stimulation (sacral nerve stimulation) are popular treatment modalities. However, appropriate treatment strategies using various neuromodulation techniques with or without pelvic floor muscle training or anticholinergics are still unclear. Further studies are needed not only to elucidate modes of action and to choose the optimal modality to improve results, but also to understand the appropriate indication and reduce morbidity and invasiveness.

Technological Improvement Rates and Evolution of Energy-Based Therapeutics

“…Optical energy stimulation has been proposed as an alternative to electrical stimulation of nerves, with the optical energy providing superior spatial resolution and contactless treatment ( 13 , 61 , 90 – 92 ). Treatment of auditory (e.g., hearing impairment), ophthalmological (e.g., retinal diseases), neurological, and psychiatric disorders (e.g., stroke, neurotrauma, neurodegeneration, and memory and mood disorders) are some key applications of the optical stimulation using infrared, laser, or in combination with chemical means, targeting cochlear and retinal nerves or the brain ( 13 , 49 , 50 , 91 ). Cochlear implant of Lockheed Martin Aculight is an exemplar device for improving the quality of hearing for patients with an auditory impairment that stimulates the cochlea optically instead of by the traditional approach using electrical stimulation ( 93 ).…”

“…Researchers have studied the influence of ELF-MF on the excitability of the human brain, using a range of frequencies (0-300 Hz, but most below 100) and extremely low intensity (in milli-and micro-Tesla), and the experimental data suggest it could affect pain sensitivity, motor system (e.g., standing balance, postural tremors), cognitive functions (e.g., reaction time, memory, visual discrimination, and flexibility), and could provide non-invasive tools for the treatment of neurologic and neuropsychiatric disorders (47,48). Another exemplar area not involving the central nervous systems is the non-invasive and passive magnetic stimulation of the pelvic floor or the sacral roots to treat urinary incontinence (stress, urgency, continuous, neurogenic, insensible) (49)(50)(51)(52). The pulsed magnetic field produces eddy currents in the excitable tissue and depolarizes the motor nerve to produce an action potential that triggers muscle contractions (53,54).…”

Neuromodulation in Management of Overactive Bladder

“…IF can improve clinical symptoms of 'wet OAB' with relatively rapidly and thereby can improve ADL levels, implying a reduced load on left ventricular function. These features suggest that IF is a favorable treatment for the elderly, and for more than 1 year continuation of all 80 patients at their own request revealed satisfactorily compliance of IF (Oh-oka, 2008 This data was modified from prior published work (Oh-oka, 2008(Oh-oka, , 2010 Before and after IF, the follows were examined. 1) frequency of IF treatment required to show optimal effects, 2) average weekly episodes of incontinence, 3) 60-min.…”