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Neuromodulation des racines sacrées : revue de littérature

Sacral root neuromodulation: review of literature

  • Revue de la Littérature / Literature Review
  • Published:
La Lettre de médecine physique et de réadaptation

Résumé

La neuromodulation des racines sacrées est une technique mini-invasive, qui consiste en l’implantation d’une électrode au contact de la troisième racine sacrée, permettant une stimulation électrique continue. Elle peut être proposée comme traitement de deuxième ligne, après échec des traitements médicamenteux et de la rééducation, en cas d’hyperactivité vésicale (pollakiurie et/ou urgenturie) avec ou sans incontinence, de rétention urinaire sans obstacle, de constipation ou d’incontinence fécale. La pose d’un neuromodulateur sacré est actuellement remboursée par l’assurance maladie dans ces indications et est en cours d’évaluation dans d’autres indications comme les douleurs pelviennes chroniques ou les troubles génitosexuels. La sélection des patients doit être rigoureuse et basée sur des critères cliniques, les patients implantés définitivement doivent avoir été améliorés d’au moins 50 % sur le trouble principal durant la phase de test. Compte tenu des bons résultats de cette technique et de la diminution du taux des complications nécessitant une réintervention, la neuromodulation semble être une alternative à des solutions chirurgicales plus lourdes et souvent irréversibles, surtout en cas d’incontinence mixte.

Abstract

Sacral neuromodulation is a minimally invasive second-line treatment for overactive bladder, urinary retention without obstruction, constipation, or fecal incontinence, in case of failure of conservative treatments. This treatment is currently reimbursed in France in these indications and is under evaluation for other indications such as chronic pelvic pain or genitosexual disorders. The selection of patients on clinical criteria must be rigorous; patients definitively implanted must have been improved at least by 50% during test phase. Regarding good results and decrease of complication rates requiring reintervention, neuromodulation seems to be an alternative to surgical solutions often irreversible, especially in cases of double incontinence.

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Authors and Affiliations

  1. Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, université de Versailles-Saint-Quentin, F-92380, Garches, France

    A. Even-Schneider, A. Schnitzler & P. Denys

  2. Service d’urologie, groupe hospitalier La Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, F-75013, Paris, France

    E. Chartier-Kastler

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  1. A. Even-Schneider
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  2. A. Schnitzler
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  3. E. Chartier-Kastler
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  4. P. Denys
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Correspondence to A. Even-Schneider.

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Even-Schneider, A., Schnitzler, A., Chartier-Kastler, E. et al. Neuromodulation des racines sacrées : revue de littérature. Lett Med Phys Readapt 26, 86–91 (2010). https://doi.org/10.1007/s11659-010-0229-9

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  • DOI: https://doi.org/10.1007/s11659-010-0229-9

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