Neuromodulation in Urology: Current Trends and Future Applications

Abstract

Urological applications of neuromodulation and neurostimulation are among the most evolving fields for these technologies. First approved for management of refractory urge incontinence, different modalities of neuromodulation and stimulation have been tested, applied and verified for a vast spectrum of voiding and pelvic floor dysfunction disorders. The modalities of delivering this treatment have also evolved in the last three decades, with a focus on sacral neuromodulation. The experimental and established "off-label" applications of neuromodulation have also encompassed chronic pelvic pain disorders, including chronic prostatitis and bladder pain syndrome, among others. In this chapter, we discuss all the hypothesized theories suggested on how this technology provides therapeutic potential for a number of chronic and debilitating urological conditions, the modes of delivery be it anterior, sacral, and posterior tibial to name a few, and the evolving and future applications.

Sacral nerve neuromodulation: the past, present and future

“…It is currently proposed that SNM creates an electrical field near the sacral nerve roots, which in turn stimulates somatic afferent modulation of the prefrontal cortex and insula, thereby suppressing reflex bladder activity such as that seen in OAB. 3 A possible central mechanism for SNM has also been hypothesised, which is supported by the significant activation of the left dorsal prefrontal cortex in patients diagnosed with OAB (Figure 1). 4 SNM is a management option that can treat a variety of disorders that significantly affect the quality of life, but it is not a common practice due to issues regarding prohibitive costs and the surgical learning curve associated with implantation.…”

“…Its mechanism of action is theoretical. It is currently proposed that SNM creates an electrical field near the sacral nerve roots, which in turn stimulates somatic afferent modulation of the prefrontal cortex and insula, thereby suppressing reflex bladder activity such as that seen in OAB 3 . A possible central mechanism for SNM has also been hypothesised, which is supported by the significant activation of the left dorsal prefrontal cortex in patients diagnosed with OAB (Figure 1).…”

Pediatric Dysfunctional Elimination: Cars and Continence—Is Electricity the Future?

“…In urology, electrical stimulation has been primarily used to treat a vast spectrum of voiding and pelvic floor disorders and in 1988, Schmidt and Tanagho began the discussions of urological applications in earnest. 2 They proposed neuromodulation and electrical stimulation of the sacral nerve. The term "neurostimulation" was later recoined to "neuromodulation," as experts in neurourology argued that electrical currents not only stimulate but also modulate the nerves involved in micturition.…”

“…The term “neurostimulation” was later recoined to “neuromodulation,” as experts in neurourology argued that electrical currents not only stimulate but also modulate the nerves involved in micturition. 2 The modern era of using neuromodulation to treat pediatric voiding disorders was initiated in 2001 by Hoebeke et al when they reported clinical effects of transcutaneous neuromodulation on refractory detrusor overactivity in children with the urge syndrome who failed anticholinergic therapy. 3 They concluded that transcutaneous neuromodulation could improve symptoms of detrusor overactivity with minimal complication.…”