Zusammenfassung
Hintergrund
Die sakrale Neuromodulation (SNM) stellt eine etablierte minimal-invasive Therapiemöglichkeit bei Funktionsstörungen des Beckenbodens dar. Ursprünglich zur Therapie von Blasenentleerungsstörung zugelassen, dient sie heute auch der Therapie von Mastdarmentleerungsstörung sowie chronischer Schmerzen im Bereich des Beckenbodens und, wenn auch noch experimentell, sexuellen Funktionsstörungen.
Fragestellung
Das folgende Kapitel gibt einen Überblick über das Verfahren der SNM.
Material und Methode
Selektiver Literaturreview.
Ergebnisse
Durch die Implantation von Sakralelektroden kann mittels elektrischer Stimulation die autonome Kontrolle der Blase und des Mastdarms beeinflusst werden, so dass je nach Stimulation eine vom Patienten kontrollierbare Hemmung oder Förderung der Entleerung erzielt werden kann. Gleichzeitig kann über diese Elektroden die Schmerzweiterleitung aus der Gegend des Beckenbodens beeinflusst werden, so dass derselbe Eingriff auch zur Schmerztherapie bei sonst therapierefraktären Schmerzen verwendet werden kann. Zuletzt werden in der Literatur Verbesserungen bei sexuellen Funktionsstörungen beschrieben, so dass sich hier potenziell eine weitere Therapieoption ergibt.
Diskussion
Die SNM stellt eine flexible und effiziente Therapieform bei Funktionsstörungen des Beckenbodens dar. Sie kann mit der gleichen Intervention, der Implantation von Sakralelektroden, gegensätzliche Störungen wie Harn‑/Stuhlverhalt und Harn‑/Stuhlinkontinenz sowie chronische, medikamentös nichttherapierbare Schmerzen behandeln.
Abstract
Background
Sacral neuromodulation is an established minimally invasive therapy indicated for the treatment of functional pelvic floor disorders. While it received its original US Food and Drug Administration (FDA) approval for the treatment of overactive bladder symptoms, it is now regarded as a therapeutic option to treat both urinary/fecal incontinence and retention. In addition, it has proven to be a valuable tool in the treatment of chronic pelvic pain, and preliminary results indicate a potential to elicit improvements in sexual functioning.
Objective
This article serves to provide a summary of the therapy and its applications.
Method
Selective literature review.
Results
Sacral neuromodulation implants allow for the controlled shifting of the autonomic control of bladder and rectum towards an inhibition or facilitation of voiding, dependent on the patient’s needs and under the patient’s control. At the same time and depending on the applied stimulation, the implants can interfere with the nerve’s conduction of pain signals. This makes them a therapeutic option for pelvic pain that fails to respond to conventional treatment. Finally, there have been first reports suggesting improvements in sexual dysfunction under sacral neuromodulation, thus, potentially opening up a new line of therapy for those disorders.
Discussion
Sacral neuromodulation is a flexible and efficient form of therapy for functional disorders of the pelvic floor. Specifically, the same intervention can treat seemingly contradictory disorders such as urinary/fecal incontinence and retention as well as chronic pain.
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J. Maciaczyk, G. Bara und F. Kurth geben an, dass kein Interessenkonflikt besteht.
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Maciaczyk, J., Bara, G. & Kurth, F. Funktionell-neurochirurgische Therapieoptionen bei Funktionsstörungen des Beckenbodens. Radiologie 63, 835–843 (2023). https://doi.org/10.1007/s00117-023-01214-8
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DOI: https://doi.org/10.1007/s00117-023-01214-8
Schlüsselwörter
- Beckenbodendysfunktion
- Sakralelektroden
- Schmerztherapie
- Blasenfunktionsstörungen
- Mastdarmentleerungsstörungen