An update on sacral neuromodulation: where do we stand with this in the management of lower urinary tract dysfunction in 2010?

Bosch, J.L.H. Ruud

doi:10.1111/j.1464-410x.2010.09702.x

Cited by 27 publications

(23 citation statements)

References 87 publications

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“…Monophasic pulses (0.2-ms pulse width) generated by an electrical stimulator (S88, Grass Medical Instruments, Quincy, MA) were delivered in each cat via a pair of hook electrodes first to the sacral DRTs and then to the sacral VRTs in the order of S1, S2, and S3. Eight different frequencies (1,3,5,7,10,15,20,30 Hz) were tested on every root in a random order to determine the effect on isovolumetric bladder contractions. Stimulation intensity was at the threshold (T) for inducing either anal sphincter or toe twitching, which was determined at the beginning of each experiment.…”

Section: Methodsmentioning

confidence: 99%

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Neural pathways involved in sacral neuromodulation of reflex bladder activity in cats

Zhang

Zhao

Shen

et al. 2013

American Journal of Physiology-Renal Physiology

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de Groat WC, Tai C. Neural pathways involved in sacral neuromodulation of reflex bladder activity in cats. Am J Physiol Renal Physiol 304: F710 -F717, 2013. First published January 2, 2013 doi:10.1152/ajprenal.00334.2012.-This study examined the mechanisms underlying the effects of sacral neuromodulation on reflex bladder activity in chloralose-anesthetized cats. Bladder activity was recorded during cystometrograms (CMGs) or under isovolumetric conditions. An S1-S3 dorsal (DRT) or ventral root (VRT) was electrically stimulated at a range of frequencies (1-30 Hz) and at intensities relative to threshold (0.25-2T) for evoking anal/toe twitches. Stimulation of DRTs but not VRTs at 1T intensity and frequencies of 1-30 Hz inhibited isovolumetric rhythmic bladder contractions. A 5-Hz DRT stimulation during CMGs was optimal for increasing (P Ͻ 0.05) bladder capacity (BC), but stimulation at 15 and 30 Hz was ineffective. Stimulation of the S1 DRT was more effective (increases BC to 144% and 164% of control at 1T and 2T, respectively) than S2 DRT stimulation (increases BC to 132% and 150% of control). Bilateral transection of the hypogastric or pudendal nerves did not change the inhibitory effect induced by S1 DRT stimulation. Repeated stimulation of S1 and S2 DRTs during multiple CMGs elicited a significant (P Ͻ 0.05) increase in BC (to 155 Ϯ 11% of control) that persisted after termination of the stimulation. These results in cats suggest that the inhibition of reflex bladder activity by sacral neuromodulation occurs primarily in the central nervous system by inhibiting the ascending or descending pathways of the spinobulbospinal micturition reflex. sacral neuromodulation; bladder; cats; stimulation SACRAL NEUROMODULATION, which is an FDA-approved therapy for the treatment of idiopathic overactive bladder or nonobstructive urinary retention (12,20), requires surgery to implant a stimulator (InterStim, Medtronic, Minneapolis, MN) and insert an electrode into a sacral foramen to stimulate a sacral spinal root. Although sacral neuromodulation has been used for more than a decade to treat urinary incontinence as well as urinary retention (3, 32), the mechanisms underlying this therapy are still uncertain (1, 10).Several mechanisms are possible to account for the effects of sacral neuromodulation on bladder function, including: 1) direct activation of motor axons innervating the external urethral sphincter (EUS), which increases urethral outlet resistance or increases EUS afferent firing that in turn modulates bladder sensory or motor pathways in the central nervous system (6,14); 2) direct activation of afferent projections to the spinal cord that in turn modulate central bladder sensory or motor pathways (4, 5, 13, 15); and 3) direct activation of afferent projections to the spinal cord that evoke sympathetic or EUS reflexes that inhibit the bladder or close the urethral outlet, respectively (11,16,30,31).This study was undertaken to establish a convenient animal model for analyzing the effects of sacral neuromodulation...

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Section: Methodsmentioning

confidence: 99%

“…Although sacral neuromodulation has been used for more than a decade to treat urinary incontinence as well as urinary retention (3,32), the mechanisms underlying this therapy are still uncertain (1,10).…”

mentioning

confidence: 99%

Neural pathways involved in sacral neuromodulation of reflex bladder activity in cats

Zhang

Zhao

Shen

et al. 2013

American Journal of Physiology-Renal Physiology

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“…In addition, the pudendal nerve is currently used as the optimal neuromodulation site for SNM because of the lack of therapeutic effects of S3 stimulation in some patients [3,10]. By contrast, pudendal nerve stimulation can provide optimal neuromodulatory effects through the simultaneous activation of S2-S4 afferents [11].…”

Section: Introductionmentioning

confidence: 99%

Chronic pudendal neuromodulation using an implantable microstimulator improves voiding function in diabetic rats

et al. 2016

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Abtract Objective. Few studies have investigated the feasibility of using chronic pudendal neuromodulation for improving voiding function in patients with diabetes who are also experiencing urinary retention. The present study investigated the effects of chronic electrical stimulation (ES) of the sensory branch of the pudendal nerve on voiding function in diabetic rats. Approach. A custom-made implantable microstimulation system was designed and manufactured for chronic implantation in normal control (NC) and diabetic rats. After three or six weeks of pudendal neuromodulation, the intravesical pressure, external urethral sphincter electromyograms (EUS-EMGs), and urine flow rate (UFR) of all rats were simultaneously recorded to assess the effects of chronic pudendal ES on voiding function. Morphological changes in pudendal axons were assessed through hematoxylin and eosin (H&E) staining. Results. Abnormal cystometric measurements, including an increased volume threshold, contraction amplitude, and residual volume (RV) as well as a decreased burst period (BP) indicated voiding dysfunction in the diabetic rats with sham ES for three or six weeks. However, real ES for three or six weeks reversed these abnormal results; these parameters became similar to those of the NC rats and, consequently, voiding efficiency (VE) increased significantly from 17%–45% to 51%–57%. The cross-sectional area and axonal density of the pudendal nerve decreased in all the diabetic rats with sham ES for six weeks; however, these values increased significantly after real ES for six weeks. Significance. This study demonstrated the feasibility of using chronic pudendal neuromodulation for improving voiding function in diabetic rats. These results may facilitate the development of an advanced neural prosthesis for restoring bladder function in clinical settings.

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“…He stated that a report of success using a binary endpoint for testing and after implantation based on a more Concerns regarding sacral neuromodulation as a treatment option for medical-refractory overactive bladder Liberman and Valiquette than 50% threshold grossly overestimates the benefits of this treatment. 9 The clinical heterogeneity in endpoints have rarely been discussed or addressed. A 50% improvement, while receiving pharmacological therapy, would hardly be considered a success by most patients, especially if they are suffering from OAB or UUI.…”

Section: Criteria For Success and Lack Of Long-term Follow-upmentioning

confidence: 99%

“…11,12 Moreover, 20% of successful peripheral nerve evaluation (PNE) will not experience the same efficacy after their permanent lead placement supporting the use of a tined lead. 9 Few studies had long-term follow-up data in outcome and complications. This is an important consideration given that follow-up has been found to be the best predictor of revision and explantation.…”

Section: Criteria For Success and Lack Of Long-term Follow-upmentioning

confidence: 99%

Concerns regarding sacral neuromodulation as a treatment option for medical-refractory overactive bladder

Liberman

Valiquette

2011

cuaj

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An update on sacral neuromodulation: where do we stand with this in the management of lower urinary tract dysfunction in 2010?

Cited by 27 publications

References 87 publications

Neural pathways involved in sacral neuromodulation of reflex bladder activity in cats

Neural pathways involved in sacral neuromodulation of reflex bladder activity in cats

Chronic pudendal neuromodulation using an implantable microstimulator improves voiding function in diabetic rats

Concerns regarding sacral neuromodulation as a treatment option for medical-refractory overactive bladder

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