Clinical efficacy of intravesical electrical stimulation on detrusor underactivity

Deng, Han; Liu, Limin; Wu, Juan; Li, Xing; Wang, Zhaoxia; Li, Wan

doi:10.1097/md.0000000000008020

Cited by 15 publications

(13 citation statements)

References 20 publications

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“…showed that IVES can improve PVR in patients with detrusor underactivity [13,23]. In our previous single‐centre pilot study, we also observed that IVES can effectively reduce PVR and improve BVE in patients with detrusor underactivity [17]. Improvement of BVE in the trial group was also significantly better than that in controls after 4 weeks of treatment.…”

Section: Discussionmentioning

confidence: 65%

“…The main efficacy index of this clinical trial was change of PVR compared with baseline at 4 weeks of treatment. According to our previous study, we expected the change of PVR from baseline in the trial group to be 150 mL at 4 weeks of treatment, and change of PVR from baseline in the control group was 40 mL at 4 weeks, with a standard deviation of 150 mL [17]. PASS 11.0 software was used for sample size estimation.…”

Section: Methodsmentioning

confidence: 99%

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Randomized controlled trial of intravesical electrical stimulation for underactive bladder

et al. 2022

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To evaluate the efficacy and safety of intravesical electrical stimulation (IVES) performed with a novel device in patients with underactive bladder (UAB). Patients and MethodsThis was a multicentre, prospective, single-blind, randomized controlled clinical trial of patients with UAB in China. Eligible patients were randomly assigned in a 1:1 ratio to receive conventional IVES (n = 38) or IVES with an open circuit (n = 38). The primary efficacy measure was change from baseline in post-void residual urine volume (PVR) after 4 weeks of treatment. Secondary efficacy measures included changes in maximum urinary flow rate (Q max ), bladder voiding efficiency (BVE), number of 24-h clean intermittent catheterization (CIC) procedures, and Patient Perception of Bladder Condition-Scale (PPBC-S) and American Urological Association Symptom Index Quality of Life (AUA-SI-QoL) scores from baseline after 4 weeks of treatment. Adverse events (AEs) were monitored throughout the trial. ResultsIn the full analysis set (FAS), the mean (SD) PVR changes in the trial and control groups at 4 weeks were À97.1 (107.5) mL and À10.5 (86.7) mL, respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): À102.9 (100.0) mL vs 0.7 (82.5) mL (P < 0.01). In the FAS and PPS, Q max improved significantly at 4 weeks (P = 0.04 and P = 0.03). In the FAS and PPS, BVE was significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas no significant differences in the number of 24-h CIC procedures, PPBC-S score or AUA-SI-QoL score were observed between the groups. Six possible therapy-related AEs occurred in six patients (four in the trial group and two in the control group; P = 0.67), all of which were urinary tract infections. No severe AEs were reported. ConclusionsThe results of this clinical study strongly demonstrate that UAB patients benefit from this novel IVES device. More research is needed to validate the clinical utility of this device.

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Section: Discussionmentioning

confidence: 65%

Section: Methodsmentioning

confidence: 99%

Randomized controlled trial of intravesical electrical stimulation for underactive bladder

et al. 2022

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“…Ez történhet a tibialis ideg bőrön keresztüli ingerlésével, kiegészítve a medencefenék izmainak stimulációjával. A hólyagon belüli (intravesicalis) stimuláció a hólyagkapacitás növelése és a hólyagürítés javulása révén lehet kedvező hatású [38].…”

Section: Invazív Kezelési Módokunclassified

A neurogén húgyhólyag klinikuma és terápiás lehetőségei

Járomi

Boros

et al. 2021

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Összefoglaló. Az alsó húgyutak fő funkciója a vizelet tárolása és ürítése, amely működések zavara az úgynevezett alsó húgyúti tünetegyüttes kialakulásához vezet, ami a kiváltó októl függően vizeletürítési zavarral és vizeletretencióval is járhat. Kezeletlen esetekben a felső húgyutak károsodása következik be a magas hólyagnyomás által kiváltott vesicoureteralis reflux következtében, amely ureter- és veseüregrendszeri tágulat kialakulására, illetve fertőzésekre és kőképződésre hajlamosít. A vizelettárolási/vizeletürítési zavarokat három fő csoportba sorolhatjuk, úgymint stressz- (terheléses) inkontinencia , hiperaktív hólyag (nedves/száraz) és neurogén hólyag. A jelen összefoglaló közlemény tárgyát képező neurogén hólyag egy gyűjtőfogalom, mely magában foglal minden, releváns neurológiai kórkép talaján kialakult vizelettárolási és vizeletürítési zavart. Mivel a húgyhólyag mellett a záróizomzat és a hátsó húgycső is érintett, ezt a kórképet napjainkban „neurogén alsó húgyúti diszfunkció” elnevezéssel is szokás illetni. A kórállapotot a neurológiai diszfunkciók széles spektruma okozhatja, kezdve a helyi funkcionális zavartól a helyi idegi sérülésen át a felső és alsó motoneuron-sérülésig vagy a centrális degeneratív folyamatokig. Az eltérő etiológia ellenére a klinikai tünetek rendszerint két alapvető klinikai típusban manifesztálódhatnak: túlműködő (fokozott detrusorkontraktilitást okozó automata) hólyag vagy alulműködő hólyag formájában. Tekintettel a neurogén alsó húgyúti diszfunkció következtében létrejövő felső húgyúti komplikációkra, a közlemény egyik célja a betegség diagnózisát segítő algoritmus bemutatása a legújabb nemzetközi szakirodalmi ismeretek alapján. A neurogén hólyag kezelése jobbára nem terjedhet ki a kiváltó ok kezelésére, ezért a jelen összefoglaló másik célja azon gyógyszeres és invazív terápiás beavatkozások összefoglalása, melyek a felső húgyutak védelmét szolgálják az alacsony hólyagnyomás fenntartása révén. Orv Hetil. 2021; 162(4): 135–143. Summary. Storage and urination are the main functions of the lower urinary tract and its lesions lead to the so-called lower urinary tract syndrome causing either urinary incontinence or retention. In untreated cases, the upper urinary tract becomes injured via a vesicoureteral reflux resulting from increased bladder pressure and resultant dilations of the ureter and the renal pelvis which predispose to infection and stone formation. Lower urinary tract storage/urination disorders can be classified as stress incontinence, hyperactive bladder (wet/dry) and neurogenic bladder. Neurogenic bladder which is the subject of this review, is a collective term that encompasses all urinary storage and emptying disorders which develop on the basis of neurological diseases. Being not only the bladder, but also the sphincter and posterior urethra (generally termed as the “bladder outlet”) affected, nowadays this condition is referred to as “neurogenic lower urinary tract dysfunction”. A wide range of neurological dysfunctions could contribute to the development of this condition, ranging from local dysfunction (autonomic dysreflexia) or local nerve injury to upper/lower motoneuron injury or central degenerative processes. Regardless of the diverse etiology, the clinical symptoms eventually manifest in two major forms, i.e., overacting (automatic bladder with increased detrusor contractility) and underactive bladder. Considering the severity of complication occurring in the upper urinary tract in response to the pathophysiological changes in the lower urinary tract, one of the aims of this paper was to present an algorithm aiming to build up a state of the art diagnosis of the disease based on current international literature data. Since treatment of the neurogenic bladder usually can not target elimination of the underlying cause, the other goal of the present paper is to summarize the pharmacological treatment regimen and invasive therapeutic interventions that protect the upper urinary tract by maintaining low pressure values in the bladder. Orv Hetil. 2021; 162(4): 135–143.

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“…However, urgency urinary incontinence did not significantly change. In a retrospective study of 89 patients with UAB stimulation sessions were performed 5 days a week for 30 mins until bladder function was normal or no further improvement was achieved 25. Stimulation parameters were as follows: 1–30 mA pulse amplitude, 10–25 Hz pulse frequency, and a 200–800 µs pulse width.…”

Section: Non-approved Modes Of Electrical Stimulation In the Treatmenmentioning

confidence: 99%

<p>Electrical stimulation in the treatment of bladder dysfunction: technology update</p>

Coolen¹,

Groen²,

Blok³

2019

MDER

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The urinary bladder has two functions: urine storage and voiding. Clinically, two major categories of lower urinary tract symptoms can be defined: storage symptoms such as incontinence and urgency, and voiding symptoms such as feeling of incomplete bladder emptying and slow urinary stream. Urgency to void with or without incontinence is called overactive bladder (OAB). Slow urinary stream, hesitancy, and straining to void with the feeling of incomplete bladder emptying are often called underactive bladder (UAB). The underlying causes of OAB or UAB can be either non-neurogenic (also referred to as idiopathic) and neurogenic, for example due to spinal cord injury or multiple sclerosis. OAB and UAB can be treated conservatively by lifestyle intervention or medication. In the case that conservative treatment does not provide sufficient benefit, electrical stimulation can be used. Sacral neurostimulation or neuromodulation (SNM) is offered as a third-line therapy to patients with non-neurogenic OAB or UAB. In SNM, the third or fourth sacral nerve root is stimulated and after a test period, a neuromodulator is implanted in the buttock. Until recently only a non-rechargeable neuromodulator was approved for clinical use. However, nowadays, a rechargeable sacral neuromodulator is also on the market, with similar safety and effectiveness to the non-rechargeable SNM system. The rechargeable device was approved for full body 1.5T and 3T MRI in Europe in February 2019. Regarding neurogenic lower urinary tract dysfunction, electrical stimulation only seems to benefit a selected group of patients.

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Clinical efficacy of intravesical electrical stimulation on detrusor underactivity

Cited by 15 publications

References 20 publications

Randomized controlled trial of intravesical electrical stimulation for underactive bladder

Randomized controlled trial of intravesical electrical stimulation for underactive bladder

A neurogén húgyhólyag klinikuma és terápiás lehetőségei

<p>Electrical stimulation in the treatment of bladder dysfunction: technology update</p>

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