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Stellenwert der Neuromodulation bei der Frau

Therapeutic value of neuromodulation in women

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Zusammenfassung

Hintergrund

Seit ihrer Einführung Anfang der 1980er-Jahre werden neuromodulative Verfahren zur Behandlung der überaktiven Blase in der klinischen Praxis eingesetzt.

Ziel der Arbeit

Fragestellung ist die Darstellung und ein Update zu den verschiedenen neuromodulativen Techniken (Tibialisnervstimulation, sakrale und pudendale Neuromodulation), Darstellung ihrer Wirksamkeit und Sicherheit, Wertung ihrer Evidenz für die klinische Praxis.

Material und Methoden

Es wurde eine Literaturrecherche basierend auf PubMed und Embase durchgeführt. Studien wurden nach den Kriterien Evidenzgrad, Aktualität, Länge des Follow-up sowie Anzahl der weiblichen Patienten nach Präferenz des Autors berücksichtigt.

Ergebnisse

Die Wirksamkeit und Sicherheit sowohl der perkutanen Tibialisnervstimulation (PTNS) als auch die der sakralen Neuromodulation (SNM) ist durch Studien mit einem Evidenzgrad von 1 belegt. Zur SNM liegen Langzeitdaten von bis zu 20 Jahren vor, während die Langzeitdaten zur PTNS limitiert sind. Permanente Implantate für die Tibialisnervstimulation sind vielversprechende neue Entwicklungen. Die pudendale Neuromodulation (PNM) eignet sich für komplexere Indikationen, ist jedoch operativ anspruchsvoller.

Schlussfolgerungen

Sowohl die PTNS als auch die SNM eignen sich für die breite Anwendung in der klinischen Praxis. Die PTNS kann als Alternative zur medikamentösen Therapie angeboten werden, während die SNM von allen neuromodulativen Verfahren die überzeugendsten klinischen Daten vorweisen kann.

Abstract

Background

Neuromodulative treatment for the treatment of overactive bladder has been used in clinical practice since its introduction in the early 1980s.

Objectives

Description and update of the various neuromodulative techniques (tibial nerve stimulation, sacral and pudendal neuromodulation), presentation of their effectiveness and safety, and evaluation of their evidence for clinical practice.

Materials and methods

Literature search in PubMed and Embase, inclusion of studies according to the following criteria: evidence level, timeliness, length of follow-up and number of female patients according to the author’s preference.

Results

The efficacy and safety of both percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) has been proven by studies with an evidence level of 1. Long-term data of up to 20 years are available for SNM, while long-term data for PTNS are limited. Permanent implants for tibial nerve stimulation are promising new developments. Pudendal neuromodulation (PNM) is suitable for more complex indications but is surgically more challenging.

Conclusions

Both PTNS and SNM are suitable for broad application in clinical practice. PTNS can be offered as an alternative to pharmacotherapy, while SNM provides the most convincing clinical data of all neuromodulative therapies.

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  1. Abteilung für Neuro-Urologie, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland

    Arndt van Ophoven

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A. van Ophoven hat in den letzten 5 Jahren Honorar für Beratertätigkeit und/oder Fortbildungsvorträge, ggf. inkl. Reisekostenerstattung von folgenden Firmen erhalten: AbbVie/Allergan, Apogepha, Astellas, Axonics, bene, Dr. Pfleger, Bayer, biogen, Coloplast, Farco, Fresenius, Sanofi, Grachtenhaus, Grünenthal, Hollister, Innocept, Ipsen, Janssen, Medice, Medtronic, Merck Serono, Novartis, Pfizer, Roche, Teva, Wellspect.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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van Ophoven, A. Stellenwert der Neuromodulation bei der Frau. Urologie 62, 153–164 (2023). https://doi.org/10.1007/s00120-022-02018-9

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