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Mechanisms of action of sacral neuromodulation

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Abstract

The lower urinary tract dysfunction encompasses voiding, postvoiding, and storage symptoms. Conventional treatment modalities include pharmacotherapy and behavioural therapy. Sacral neuromodulation (SNM) is a safe and minimally invasive treatment modality that has recently gained wide acceptance in the management of urinary urge incontinence, urge frequency, and nonobstructive urinary retention, in particular, among those patients with conditions refractory to conventional methods. We searched multiple electronic databases through June 30, 2009 for eligible studies. We examined published clinical and experimental studies concerning the mechanisms of action of SNM. In the first part of the manuscript, we describe the anatomy and functions of the lower urinary tract including the reflexes involved in its functions and then review the pathophysiology of major types of the lower urinary tract dysfunction. In the second part, we discuss different ways for SNM to control various types of voiding dysfunction. The lower urinary tract dysfunctions affect millions of people worldwide and have a severe impact on their quality of life. SNM offers a safe and minimally invasive modality in the treatment of voiding dysfunctions, especially in patients with conditions refractory to conventional therapies.

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Acknowledgments

Mohamed S. Elkelini is supported by a postdoctoral fellowship from the Canadian Institutes of Health Research (CIHR)/Canadian Foundation for Research on Incontinence.

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Authors and Affiliations

  1. Division of Urology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada

    Mohamed S. Elkelini, Amal Abuzgaya & Magdy M. Hassouna

  2. Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    Mohamed S. Elkelini & Magdy M. Hassouna

  3. Department of Surgery, Division of Urology, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, MP 8-306, Toronto, Ontario, M5T 2S8, Canada

    Magdy M. Hassouna

Authors
  1. Mohamed S. Elkelini
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  2. Amal Abuzgaya
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  3. Magdy M. Hassouna
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Correspondence to Magdy M. Hassouna.

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Elkelini, M.S., Abuzgaya, A. & Hassouna, M.M. Mechanisms of action of sacral neuromodulation. Int Urogynecol J 21 (Suppl 2), 439–446 (2010). https://doi.org/10.1007/s00192-010-1273-3

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  • DOI: https://doi.org/10.1007/s00192-010-1273-3

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