Posterior Tibial Nerve Stimulation as Neuromodulative Treatment of Lower Urinary Tract Dysfunction

Balken, Michael R. van; Vandoninck, Vera; Gisolf, Karel W.H.; Vergunst, H.; Kiemeney, Lambertus A.; Debruyne, F.M.J.; Bemelmans, Bart L.H.

doi:10.1016/s0022-5347(05)65863-6

Cited by 187 publications

(111 citation statements)

References 17 publications

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“…Reports on clinical outcome were published recently. [3][4][5][6] As part of this study sexual functioning has been evaluated as well as possible effects of PTNS on sexual impairment.…”

Section: Methodsmentioning

confidence: 99%

Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation

2006

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In this study, we evaluated the effect of lower urinary tract dysfunction and its neuromodulative therapy on sexual functioning. We studied 121 patients with an overactive bladder (OAB) (N ¼ 83), chronic pelvic pain (N ¼ 23) and nonobstructive retention (N ¼ 15), which were treated with neuromodulation (i.e. percutaneous tibial nerve stimulation, PTNS). To obtain information on their sexual function, a self-administered standardized questionnaire was filled out before therapy as well as after 12 weeks of treatment. Before therapy, different aspects of sexual life were considered not normal in 25.3-45.6% of the cases. This improved significantly after treatment. Patients most likely to benefit were women, patients with an OAB and subjective responders. The aspects of sexual life which mostly improved were overall satisfaction, libido and the frequency of sexual activities. Sexual dysfunction is observed in a lot of patients with lower urinary tract disorders and may improve on successful therapy for the latter.

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“…Reports on clinical outcome were published recently. [3][4][5][6] As part of this study sexual functioning has been evaluated as well as possible effects of PTNS on sexual impairment.…”

Section: Methodsmentioning

confidence: 99%

Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation

2006

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“…Artigos utilizando várias metodologias de eletroestimulação periférica (peri-tibial, suprapúbica, perisacral, perineal e outras) foram descritos, com melhora ou cura em várias coortes de adultos com disfunção miccional (perío-do médio de tratamento de 12 semanas, uma vez/semana) [11][12][13] . Alguns autores usam acupuntura clássica, também com bons resultados [14][15] .…”

Section: Discussionunclassified

O uso da neuromodulação no tratamento das disfunções de eliminações

Jesus

Nery

2007

Rev. Col. Bras. Cir.

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RESUMO: Objetivo: Apresentar a experiência clínica com o uso de neuromodulação através de eletroestimulação transcutânea no tratamento das disfunções de eliminação. Métodos: Foram analisados retrospectivamente seis pacientes com disfunções de eliminação submetidos à neuromodulação através de eletroestimulação percutânea peri-sacral. Todos os pacientes incluídos eram refratários ao tratamento clínico convencional e a eletroestimulação foi utilizada como terapia de resgate. As sessões terapêuticas eram semanais e o seguimento mínimo foi de seis meses. Resultados: Todos os pacientes obtiveram melhora clínica. Quatro pacientes não necessitaram de mais medicação. Todos aceitaram bem o tratamento e referiram melhora da qualidade de vida. Conclusão: A eletroestimulação percutânea mostrou-se útil no tratamento das disfunções do assoalho pélvico e da musculatura vesical (Rev. Col. Bras. Cir. 2007; 34(6): 392-397 INTRODUÇÃOOs últimos 20 anos trouxeram grandes mudanças conceituais com relação aos distúrbios funcionais da musculatura pelvi-perineal. A correlação fisiopatológica entre os distúrbios vesicais e os da evacuação foi fundamental: o funcionamento integrado (neuro-muscular) do assoalho perineal representou uma explicação satisfatória para a associação freqüente entre constipação crônica e problemas urológicos, a seguir denominada síndrome da disfunção das eliminações Koff et al ¹.Novas linhas de pesquisa sugeriram um papel fundamental, previamente ignorado, das informações neurais aferentes na coordenação dos tratos urinário e intestinal distais. O urotélio tem um papel integrativo, atuando como um sincício funcional com funções proprioceptivas.Exames ´in vivo´ com PET-scan demonstraram a existência de modulação funcional do aparelho urinário e assoalho pélvico em vários níveis do sistema nervoso central.A alta frequência de efeitos colaterais sérios com drogas anticolinérgicas e a relativa ineficácia do tratamento com laxativos, técnicas funcionais e drogas moduladoras da atividade vesical determinaram a busca de novas táticas terapêuticas.Apresentamos a nossa experiência clínica com o uso de eletroestimulação percutânea (EP) semanal perisacra no tratamento de uma coorte selecionada de portadores de distúrbios graves das funções de eliminação, previamente refratários ao tratamento clínico durante longos períodos. MÉTODOSForam analisados os prontuários de seis pacientes cujas idades variavam entre 5 e 14 anos que apresentavam disfunções de eliminação e foram submetidos à eletroestimulação percutânea (EP) peri-sacra (S2 -S4) e torácica (T11 -L2). A EP foi aplicada uma vez por semana com duração de 40 minutos cada uma durante 10 semanas.O tratamento foi ministrado por um cirurgião pediatra, responsável pela análise e seguimento clínico dos casos e um médico acupunturista, responsável pela aplicação da EE e análise clínica dos pacientes durante as sessões. Em todos os pacientes aqui apresentados a eletroestimulação foi utilizada como terapia de resgate. Foram excluídas da análise todas as crianças que apresentavam d...

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“…An additional 26% of the patients had a 25-50% reduction in their residuals. Van Balken et al (10), in their study, reported a decrease in the number and volume of catheterization in 12 patients with idiopathic urinary retention treated with PTNS. We used PTNS due to its minimally invasive nature with same principal of effect, but we could not obtain any improvement.…”

Section: Discussionmentioning

confidence: 93%

Chronic Urinary Retention after Surgery for a Rare Case of Adult Presacral Teratoma

Uğurlucan¹,

İyibozkurt²,

Karamustafaoğlu³

et al. 2014

Balkan Med J

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Teratomas are neoplasms made up of cells derived from all three germ layers. Retroperitoneal teratomas make up 1-11% of primary retroperitoneal tumors, are very rarely encountered during adulthood and have a 50-67% rate of malignant transformation (1). These neoplasms are usually asymptomatic, but may cause obstructive symptoms as the size increases. Surgical resection and histopathology are required for diagnosis and treatment.Radical pelvic surgery may cause pelvic plexus and nerve injury and lead to bladder dysfunction and urinary retention with an incidence of 15-20% (2). Here, we report a case with chronic urinary retention after surgery for a rare case of adult presacral teratoma. CASE PRESENTATIONA 24-year-old female presented with abdominal distention and pain. Abdominal/gynecologic examination and sonography revealed a mass measuring 18x12x12 cm posterior to the uterus. Magnetic resonance imaging showed a mass measuring 16x18x11 cm, anterior to the rectosigmoid area suggestive of a teratoma with high-intensity signaling on T1-weighted images ( Figure 1). There was no invasion of the adjacent structures, but bilateral mild hydronephrosis was observed. The uterus and the right ovary were normal, but the left ovary could not be visualized with magnetic resonance imaging probably due to the overlying mass. The tumor markers were normal.The abdomen was entered through a midline incision. A 20 cm retroperitoneal mass anterior to the sacrum was observed. The ovaries and other abdominal structures were normal. The retroperitoneum was entered and the mass was dissected from the rectum and the sigmoid colon and the left ureter and was completely excised. The histopathology was mature cystic teratoma. The Foley catheter was removed on the postoperative third day, but spontaneous micturition was not possible. The Foley catheter was introduced again and bladder retraining with clamping the Foley catheter for three hours and draining the bladder every three hours was performed for 10 days, but spontaneous micturition was still not possible. Urinalysis, urine culture, and computed tomography scans were normal. Clean intermittent catheterization was taught and urodynamics were performed. The maximum bladder capacity was 750 mL, and the first sensation of urine was at 748 mL. The maximum detrusor pressure was 12 cmH 2 O. Electromyography of the external anal sphincter showed chronic denervation-reinnervation. The bulbocavernous reflex was normal. The patient continued clean intermittent catheterization for six months and urodynamics and pressure-flow studies were performed again six months later. The first sensation of urine was at 160 mL. The maximum bladder capacity was 454 mL. Compliance was 14 mL/cmH 2 O. Micturition was still not possible. The maximum detrusor pressure was 48 cmH 2 O. Informed consent was obtained from the patient and ethical consent was obtained from the local ethics committee for posterior tibial nerve stimulation (PTNS). PTNS was performed as 30-minute Background: Presacral teratomas are usually...

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Posterior Tibial Nerve Stimulation as Neuromodulative Treatment of Lower Urinary Tract Dysfunction

Cited by 187 publications

References 17 publications

Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation

Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation

O uso da neuromodulação no tratamento das disfunções de eliminações

Chronic Urinary Retention after Surgery for a Rare Case of Adult Presacral Teratoma

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