Sakrale Neuromodulation bei neurogenen Blasenfunktionsstörungen

Kessler, Thomas M.; Wöllner, Jens; Kozomara, Marko; Mordasini, Livio; Mehnert, Ulrich

doi:10.1007/s00120-011-2779-0

Cited by 11 publications

(6 citation statements)

References 22 publications

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“…The mechanism of action of SNM has not been completely elucidated, but afferent nerves most probably play a significant part. It appears that SNM yields a modulation of medullary reflexes and brain centres by peripheral afferents [4] . The technique has been accepted since 1997 by the USA Food and Drug Administration (FDA) and has been effectively used in patients with different types of lower urinary tract dysfunction, comprising urgency, frequency and UUI, in addition to NOUR [5] .…”

Section: Introductionmentioning

confidence: 99%

The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction

Al-Azzawi

Al-Tamimi

2018

Arab Journal of Urology

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ObjectivesTo present our experience, in Iraq, with sacral neuromodulation (SNM) in patients with refractory lower urinary tract dysfunction, with discussion of the factors that affect the response rate.Patients and methodsIn this prospective, clinical, interventional study, 24 patients were evaluated and treated by a team comprised of a Urologist and a Neurosurgeon with SNM over a 1.5-year period. The gender, age, pathology, and clinical presentation, were all studied and evaluated. Successful clinical response was defined as achieving a ≥50% improvement in voiding diary variables.ResultsThe mean age of those that responded to SNM was 28 years, with females responding better than males (10 of 14 vs four of 10). The SNM response rate according to presentation was six of 10 in those with overactive bladder/urge urinary incontinence, six of nine of those with urinary retention, and two of five in those with a mixed presentation. The response rate in idiopathic voiding dysfunctions was 11 of 13, whilst for neurogenic dysfunctions it was three of 11. Other benefits such as in bowel motion, erectile function, menstruation, power of lower limbs, and quality of life (QoL), were also recorded. The complications were reasonable for this minimally invasive procedure.ConclusionSNM offers a good and durable solution for some functional bladder problems, if patients are well selected. There may also be additional extra-urinary benefits that contribute to improvements in QoL. SNM was well tolerated by our patients with an encouraging response rate, especially in psychologically stable patients with idiopathic dysfunctions.

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Section: Introductionmentioning

confidence: 99%

The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction

Al-Azzawi

Al-Tamimi

2018

Arab Journal of Urology

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“…This in turn stimulates somatic afferents which modulate higher center control of micturition including the prefrontal cortex and insula, by restoring normal bladder function and perhaps suppressing reflex bladder activity such as that seen in overactive bladder (OAB). This indirect effect both on the bladder and the urinary sphincter is achieved through adaptive neural plasticity, and thus, an intact neural system, at least distally, is a neural requirement for SNM to successfully restore Neuromodulation in Urology: Current Trends and Future Applications DOI: http://dx.doi.org /10.5772/intechopen.92287 bladder function [15][16][17][18][19][20][21]. The SNM device can provide different levels of stimulation, which may further modulate efferents to the bladder-sphincter complex; however, it does not have any direct effect on urethral resistance [16,22].…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Neuromodulation in Urology: Current Trends and Future Applications

Yaiesh¹,

Al‐Terki²,

Al-Shaiji³

2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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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.

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“…It appears to involve modulation of spinal cord reflexes and brain centers via peripheral afferents (genital, tibial and sacral afferents). (133) A recent review on the use of this modality reports that it can be successful in certain carefully selected neurological populations. However, no definitive conclusions can be drawn from the available evidence at this point.…”

Section: Kavanagh Et Al Guideline: Neurogenic Bladdermentioning

confidence: 99%

Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text

Kavanagh¹,

Baverstock²,

Campeau³

et al. 2019

CUAJ

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The term 'neurogenic bladder' describes lower urinary tract dysfunction that has occurred likely as a result of a neurological injury or disease (1) . The International Continence Society (ICS) defines 'neurogenic lower urinary tract dysfunction' (NLUTD) as 'lower urinary tract dysfunction due to disturbance of the neurologic control mechanism.' This broad definition is used to describe a multitude of conditions of varying severity.Common causes of NLUTD include: spinal cord injury (SCI), multiple sclerosis (MS) and myelomeningocele (MMC). Other causes of NLUTD include: Parkinson's disease, cerebrovascular accidents, traumatic brain injury, brain or spinal cord tumor, cauda equina syndrome, transverse myelitis, multisystem atrophy, pelvic nerve injury and diabetes.It is well described that neurological disorders can lead to urologic complications including: urinary incontinence, UTIs, urolithiasis, sepsis, ureteric obstruction, vesicoureteric reflux (VUR) and renal failure (2) . Due to the potential morbidity, and even mortality, initial investigation, ongoing management and surveillance is warranted in this patient population. Despite the frequency and potential severity of NLUTD, there are few high-quality studies in the literature to guide urological practices. CUAJ -CUA Guideline Kavanagh et al Guideline: Neurogenic bladderPrior neurogenic guidelines vary in their clinical assessment, investigations utilized and surveillance strategies (2)(3)(4)(5)(6) . The primary reason is that there is limited evidence to support a common strategy. The purpose of this guideline is to help urologists to identify high-risk patients with NLUTD and to provide an approach to the management and surveillance of patients with NLUTD. ClassificationThe etiology of a NLUTD is often classified based on whether the primary lesion is suprapontine, suprasacral, sacral or infrasacral (7) . A complementary system was developed by Madersbacher et al. based on the function of the detrusor muscle and of the external sphincter (8) . These systems allow a physician to have a general idea of how the lower urinary tract is likely to behave in SCI patients with more complete injuries. (Figure 1). Newer systems using MR urography in combination with urodynamics (UDS) have also been proposed. (9) MethodologyThis review was performed according to the methodology recommended by the Canadian Urologic Association (10) . EmBASE and Medline databases were used to identify literature relevant to the early urological care of NLUTD patients. Recommendations were developed by consensus and graded using a modified Oxford system which identifies level of evidence (LOE) and grade of recommendation (GOR). This complete version includes the full text of the guidelines (including the sections in the executive summary). Canadian epidemiology of neurogenic bladderThere are 3.7 million Canadians living with a neurologic condition, (11,12) three common types of neurologic conditions are Multiple Sclerosis (MS), Spina Bifida (SB) and Spinal Cord Injury (SCI). In ...

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Sakrale Neuromodulation bei neurogenen Blasenfunktionsstörungen

Cited by 11 publications

References 22 publications

The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction

The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction

Neuromodulation in Urology: Current Trends and Future Applications

Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text

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