Abstract
Bladder dysfunction is a very prevalent disorder and often refractory to behavioral and pharmacologic therapies. Sacral nerve stimulation is an approved method of managing urinary urgency, frequency, urge incontinence, and urinary retention. Alternative approaches to neuromodulation are being developed. The purpose of this paper is to describe emerging approaches to neuromodulation for voiding dysfunction. A current review of alternative methods of neuromodulation is discussed. This includes stimulation of the tibial nerve via a percutaneous approach, methods of stimulating the pudendal nerve to obtain afferent stimulation through sacral roots S2–S4, chemo-neuromodulation using botulinum toxin, and anogenital stimulation. These various methods are described and the current literature reviewed. Neuromodulation is an alternative to traditional management of voiding dysfunction. A benefit of neuromodulation is that it is minimally invasive and reversible. New sites of stimulation are being developed to add to our treatment options.
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References
Wein AJ, Rovner ES (2002) Definition and epidemiology of overactive bladder. Urology 60(5 suppl 1):7–12
Tyagi S, Thomas CA, Hayashi Y et al (2006) The overactive bladder: epidemiology and morbidity. Urol Clin N Am 33:433–438
Tanagho EA, Schmidt RA, Orvis BR (1989) Neural stimulation for control of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders. J Urol 142:340–345
Sherman ND, Amundsen CL (2007) Current and future techniques of neuromodulation for bladder dysfunction. Curr Urol Rep 8:448–454
Cooperberg MR, Stoller ML (2005) Percutaneous neuromodulation. Urol Clin N Am 32:71–78
Govier F, Litwiller S, Nitti V et al (2001) Percutaneous afferent modulation for the refractory over active bladder: results of a multicenter study. J Urol 165:1193–1198
Van Balken MR, Vandoninck V, Gisolf K et al (2001) Posterior tibial nerve stimulation as neuromodulatory treatment of lower urinary tract dysfunction. J Urol 166:914–918
Amarenco G et al (2003) Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169(6):2210–2215
McGuire EJ, Shi-Chun Z, Horwinski ER (1983) Treatment for motor and sensory detrusor instability by electrical stimulation. J Urol 129:78–84
Okada N, Igawa Y, Ogawa Y et al (1998) Transcutaneous electrical stimulation of thigh muscles in the treatment of detrusor overactivity. Br J Urol 81:560–564
Vereecker RL, Das RJ, Grisar P (1984) Electrical sphincter stimulation in the treatment of detrusor hyperreflexia of paraplegia. Neurourol Urodyn 3:145–149
Vandoninck V et al (2004) Posterior tibial nerve stimulation in the treatment of voiding dysfunction. Neurourol Urodyn 23:246–251
Van Balken M et al (2001) Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol 166:914–918
Ruiz BC (2004) Peripheral afferent nerve stimulation for treatment of lower urinary tract irritative symptoms. Eur Urol 45:65–69
Zhao J et al (1994) Posterior tibial nerve stimulation in patients with intractable interstitial cystitis. BJU Int 94(Issue 1):101
Peters KM, MacDiarmid SA, Wooldridge LS et al (2010) Randomized trial of percutaneous tibial nerve stimulation versus extended release tolterodine: Results from the overactive bladder innovative therapy (OrBIT) trial. J Urol 183:1438–1443
Peters KM, Carrico DJ, Perez-Marrero RA et al (2010) Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: Results of the SUmit trial. J Urol 183(4):1438–1443
Huang JC, Deletis V, Vodusek DB et al (1997) Preservation of pudendal affferents in sacral rhizotomies. Neurosurgery 41:411–415
Beco J, Climov D, Bex M (2004) Pudendal nerve decompression in perineology: a case series. BMC Surg 4:15
Popeney C, Ansell V, Renney K (2007) Pudendal entrapment as an etiology of chronic perineal pain: diagnosis and treatment. Neurourol Urodyn 26:820–827
Peters KM, Feber KM, Bennett RC (2005) Sacral versus pudendal nerve stimulation for voiding dysfunction: a prospective, single-blinded, randomized, crossover trial. Neurourol Urodyn 24:643–647
Peters KM, Feber KM, Bennett RC (2007) A prospective, single-blind, randomized crossover trial of sacral vs. pudendal nerve stimulation for interstitial cystitis. BJU Int 100:835–839
Spinelli M, Malaguti S, Giardiello G, Lazzeri M, Tarantola J, Van Den Hombergh U (2005) A new minimally invasive procedure for pudendal nerve stimulation to treat neurogenic bladder: description of the method and preliminary data. Neurourol Urodyn 24:305–309
Groen J, Amiel C, Ruud Bosch JLH (2005) Chronic pudendal nerve neuromodulation in women with idiopathic refractory detrusor overactivity incontinence: Results of a pilot study with a novel minimally invasive implantable mini-stimulator. Neurourol Urodyn 24:226–230
Bosch JLHR (2005) The Bion device: a minimally invasive implantable ministimulator for pudendal nerve neuromodulation in patients with detrusor overactivity incontinence. Urol Clin North Am 32:109–112
Nissenkorn I, De Jong PR (2005) A novel surgical technique for implanting a new electrostimulation system for treating female overactive bladder: a preliminary report. BJU Int 95(9):1253–1258
Petit H, Wiart E, Gaujard E et al (1998) Botulinum A toxin treatment of detrusor-sphincter dyssynergia in spinal cord disease. Spinal Cord 36:91–94
Smith CP, Franks ME, McNeil BK et al (2003) Effect of botulinum toxin A on the autonomic nervous system of the rat lower urinary tract. J Urol 169:1896–1900
Wakabayashi Y, Kojima Y, Makiura Y et al (2005) Acetylcholinesterase positive axons in the mucosa of urinary bladder in cats: retrograde tracing and regeneration studies. Histol Histopathol 10:523–530
Khera M, Somogyi GT, Kiss S et al (2004) Botulinum toxin A inhibits ATP release from bladder urothelium after chronic spinal cord injury. Neurochem Int 45:987–993
Sahai A, Khan MS, Dasgupta P (2007) Efficacy of botulinum toxin-A for treating idiopathic detrusor overactivity: results from a single center, randomized, double-blind, placebo controlled trial. J Urol 177:2231–2236
Schmid DM, Sauermann P, Werner M et al (2006) Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics. J Urol 176:177–185
Schurch B, de Seze M, Denys P et al (2005) Botulinum toxin type A is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol 174:196–200
Geirsson G, Fall M (1997) Maximal functional electrical stimulation in routine practice. Neurourol Urodyn 16:550–565
Ohlsson BL (1988) Effect of some different pulse parameters on the perception of intravaginal and intra-anal electrical stimulation. Med Biol Eng Comput 26:503–508
Primus G, Kramer G (1996) Maximal external electrical stimulation for treatment of non-neurogenic urinary urgency and/or urge incontinence. Neurourol Urodyn 15:187–194
Eriksen BC, Bergmann S, Eik-Nes SH (1989) Maximal electrode stimulation of the pelvic floor in female idiopathic detrusor instability and urge incontinence. Neurourol Urodyn 8:219–230
Salvesen BH, KA EBC, Kulseng-Heanssen S (1998) Long-term effects ten years after maximal electrostimulation of the pelvic floor in women with unstable detrusor and urge incontinence. Acta Obstet Gynecol Scand 77(suppl 168):22–24
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The author serves as a consultant and an investigator for Medtronic, Inc., and a consultant and an investigator for Uroplasty, Inc.
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Peters, K.M. Alternative approaches to sacral nerve stimulation. Int Urogynecol J 21, 1559–1563 (2010). https://doi.org/10.1007/s00192-010-1282-2
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DOI: https://doi.org/10.1007/s00192-010-1282-2