Applications of Neurostimulation for Urinary Storage and Voiding Dysfunction in Neurological Patients

Abstract

The application of various forms of electrical stimulation is considered a therapeutic option to manage different types of lower urinary tract dysfunction. However, even though lower urinary tract dysfunction is common in patients with neurological disease, apart from patients with spinal cord injury, electrostimulation is still not widely applied in a neurological patient population. Urologists frequently encounter patients with neurogenic lower urinary tract dysfunction in their daily practice. Often, the conservative treatment modalities do not offer adequate relief of symptoms in these patients. In most cases, surgical options including transurethral stents, augmentation cystoplasty stoma or derivation surgery are considered a last resort. With this in mind, it is essential that healthcare professionals are informed about the possibilities of nerve stimulation in neurogenic patients. We review the utilization and the results of electrical stimulation by means of pudendal nerve stimulation, stimulation of the sacral nerve roots and lower limb stimulation in patients with neurogenic detrusor overactivity.

Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis

“…Sacral neuromodulation (SNM) for the treatment of detrusor disorders has been used since the 1960s and it has been approved by the Food and Drug Administration (FDA) since the 1990s for refractory voiding dysfunction, urgency incontinence, urgency-frequency syndrome and nonobstructive urinary retention [18,19]. SNM has gained popularity as an approach in NDO since the 1980s and in 2005 it was included in treatment recommendations for idiopathic and NDO as a second-line treatment [18][19][20].…”

“…SNM has gained popularity as an approach in NDO since the 1980s and in 2005 it was included in treatment recommendations for idiopathic and NDO as a second-line treatment [18][19][20]. The mechanism of action of SNM is not fully understood, but it has been shown to be effective in treating apparently opposite bladder disorders such as refractory OAB, voiding dysfunctions and chronic urinary retention, all of which are very common in MS patients [19].…”

“…In 2000, Chartier-Kastler et al [22] suggested that stimulation of somatic afferent axons in the spinal roots would modulate voiding and continence reflexes in the CNS. The mechanism is thought to be somatic afferent inhibition of sensory processing in the spinal cord [18,22,23]. Hohenfellner et al [24] described the effects on bladder sensitivity of excitation of the pudendal somatomotor neurons combined with modulation of efferent sympathetic and parasympathetic activity.…”

Detrüsör Aşırı Aktivitesi Olan Omurilik Hasarlı Olgularda Sakral Dermatomal Transkutanöz Nörostimülasyon

“…Nöromodülasyon nörojenik ve nörojenik olmayan alt üriner sistem disfonksiyonu tedavisinde intravezikal elektriksel stimülasyon, direk mesane stimülasyonu, pelvik sinir stimülasyonu, pudendal sinir stimülasyonu, sakral spinal stimülasyon, dorsal rizotomi ile birlikte sakral anterior kök stimülasyonu, uyluk kaslarının elektriksel stimülasyonu, posterior tibial sinir stimülasyonu ve TENS (suprapubik veya S2-S3 dermatomlarına) gibi birçok değişik teknik ve cihazlarla uygulanmaktadır (4,14,(17)(18)(19)(20)(21)(22). S3 segmental sinir köklerinin cerrahi yöntemlerle implante edilen elektrotlarla direkt elektriksel stimülasyonu sonucu nörojenik detrüsör aşırı aktivitesinde başarılı sonuçlar alınması, daha kolay uygulanabilen, invaziv olmayan, belirgin yan etkisi bulunmayan, tedavi maliyeti daha düşük bir yöntem olan S3 dermatomuna yüzeyel elektrotlar ile TENS uygulamasını gündeme getirmiştir (4-7).…”

Intérêt thérapeutique de la stimulation transcutanée tibiale postérieure dans les troubles mictionnels irritatifs de la sclérose en plaques. Résultats d’un programme de recherche clinique hospitalier multicentrique

“…La majorité de ces modalités de stimulation n'est plus utilisée aujourd'hui en raison de leur faible faisabilité limitant leur administration ambulatoire en pratique quotidienne, ou du caractère transitoire et bref de leur efficacité. La neuromodulation des racines sacrées demeure une modalité d'électrostimulation pertinente dans l'HAV idiopathique, mais son intérêt à long terme chez les patients neurologiques et dans la SEP reste débattu [7][8][9][10].…”