Stimulation signal modification in a porcine model for suppression of unstable detrusor contractions

Braun, P.M.; Seif, C.; Bross, S.; Portillo, F. J. Martínez; Alken, P.; Jünemann, Klaus-Peter

doi:10.1016/s0090-4295(02)02403-2

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…[16] showed that an inflammation‐induced increase of micturition frequency could be decreased by application of SNM. Therefore we chose to investigate the efficacy of unilateral vs bilateral SNM in the Goettinger mini‐pig with formalin‐induced cystitis resulting in detrusor hyperactivity [17].…”

Section: Discussionmentioning

confidence: 99%

Unilateral vs bilateral sacral neuromodulation in pigs with formalin‐induced detrusor hyperactivity

et al. 2008

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OBJECTIVE To investigate the efficacy of unilateral vs bilateral sacral neuromodulation (SNM) under standard experimental conditions by stimulating the dorsal sacral roots in pigs with formalin‐induced detrusor hyperactivity. MATERIALS AND METHODS After lumbosacral laminectomy in eight α‐chloralose‐anaesthetized Göttinger mini‐pigs, the dorsal roots of the nerve S3 were inserted into separate compartments of a size‐modified Brindley electrode. Detrusor hyperactivity was induced by intravesical instillation of a 0.25% formalin solution. Stimulation of the separated dorsal roots was performed on the unilateral right, respectively, the unilateral left side, as well as bilaterally and with stimulation off‐phases in a randomized pattern. A biphasic rectangular signal (impulse 200 µs, 20 Hz, 2.0 V) was used for SNM. The bladder pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. RESULTS During unilateral stimulation, the mean (sem) number of contractions was reduced significantly from 4.73 (0.66) to 2.73 (0.62). The amplitude was also reduced significantly from 12.86 (1.23) to 8.32 (0.66). By contrast, bilateral stimulation lowered the mean (sem) number of overactive detrusor contractions to 1.08 (1.02) and the amplitude to 3.08 (2.42), which are highly significant reductions. CONCLUSION In this porcine model, bilateral neurostimulation was a more effective method of SNM than unilateral stimulation. We assume that this is due to the additive effect of stimulating both sides, as well as the greater chance of stimulating the relevant dorsal roots of the sacral nerve fibres. By contrast, unilateral neuromodulation may be only partially effective by not being capable of influencing the entire bladder, or possibly by allowing new formation of neuronal pathophysiological pathways.

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Section: Discussionmentioning

confidence: 99%

Unilateral vs bilateral sacral neuromodulation in pigs with formalin‐induced detrusor hyperactivity

et al. 2008

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“…Furthermore, SNM during the last 50% of bladder filling appeared to be the most optimal (24). In addition, a sinusoidal and quasi‐trapezoidal signal seemed to be more organ‐specific and inhibited induced detrusor overactivity more, respectively (21, 22). Both results were only reported in one study making it hard to draw definite conclusions from this data.…”

Section: Discussionmentioning

confidence: 99%

“…Using rectangular SNM, evoked bladder pressure decreased with an increased amplitude (higher than 6 V) which did not occur using sinusoidal SNM. It was concluded that rectangular SNM has many harmonics that stimulate other nerve fibers and that "cleaner" sinusoidal SNM may result in a more organspecific stimulation (16,21,22). Further analysis of the effect of stimulation signal revealed that quasi-trapezoidal SNM inhibited induced detrusor overactivity significantly more than the conventional rectangular SNM (21,22).…”

Section: Effect Of Stimulation Signalmentioning

confidence: 99%

Sacral Neuromodulation for Lower Urinary Tract and Bowel Dysfunction in Animal Models: A Systematic Review With Focus on Stimulation Parameter Selection

Douven

Assmann

Breukink

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objective: Conventional sacral neuromodulation (SNM) has shown to be an effective treatment for lower urinary tract and bowel dysfunction, but improvements of clinical outcome are still feasible. Currently, in preclinical research, new stimulation parameters are being investigated to achieve better and longer effects. This systematic review summarizes the status of SNM stimulation parameters and its effect on urinary tract and bowel dysfunction in preclinical research. Materials and Methods: The literature search was conducted using three databases: Ovid (Medline, Embase) and PubMed. Articles were included if they reported on stimulation parameters in animal studies for lower urinary tract or bowel dysfunction as a primary outcome. Methodological quality assessment was performed using the SYRCLE Risk of Bias (RoB) tool for animal studies. Results: Twenty-two articles were eligible for this systematic review and various aspects of stimulation parameters were included: frequency, intensity, pulse width, stimulation signal, timing of stimulation, and unilateral vs. bilateral stimulation. In general, all experimental studies reported an acute effect of SNM on urinary tract or bowel dysfunction, whereas at the same time, various stimulation settings were used. Conclusions: The results of this systematic review indicate that SNM has a positive therapeutic effect on lower urinary tract and bowel dysfunction. Using low-frequency-SNM, high-frequency-SNM, bilateral SNM, and higher pulse widths showed beneficial effects on storage and evacuation dysfunction in animal studies. An increased variability of stimulation parameters may serve as a basis for future improvement of the effect of SNM in patients suffering from urinary tract or bowel dysfunction.

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Sakrale Neuromodulation in der Behandlung von Funktionsst�rungen des unteren Harntrakts

et al. 2003

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Over the last few years, sacral neuromodulation has become an established treatment option for dysfunctions of the lower urinary tract. It fills the gap that used to exist between conservative therapy and costly invasive methods such as urinary drainage via a deactivated bowel segment. Initially, the clinical value of sacral neuromodulation was controversial even among neurourologists. This was mainly due to a lack of understanding of the physiological processes, uncertain diagnostics, the design of the hardware, and a surgical topography relatively unknown to the urologist. In the meantime, however, sacral neuromodulation has become a standard part of clinical routine with respect to the treatment of dysfunctions of the lower urinary tract, and it is regularly employed in various urological institutions across Europe and the USA. This form of treatment, which is the final straw for patients who believed themselves-after many frustrated therapy attempts-to be "hopeless cases," can now also successfully be employed as an ambulatory measure. The latest data from our hospital, as well as contributions presented at the last DGU Congress in Wiesbaden, indicate that patients with neurogenic urinary retention are the most likely to profit from this treatment option.

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Stimulation signal modification in a porcine model for suppression of unstable detrusor contractions

Cited by 4 publications

References 22 publications

Unilateral vs bilateral sacral neuromodulation in pigs with formalin‐induced detrusor hyperactivity

Unilateral vs bilateral sacral neuromodulation in pigs with formalin‐induced detrusor hyperactivity

Sacral Neuromodulation for Lower Urinary Tract and Bowel Dysfunction in Animal Models: A Systematic Review With Focus on Stimulation Parameter Selection

Sakrale Neuromodulation in der Behandlung von Funktionsst�rungen des unteren Harntrakts

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