Skip to main content

Advertisement

SpringerLink
Log in

The Role of Neuromodulation in Patients with Neurogenic Overactive Bladder

  • Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

To review the treatment options for patients with neurogenic overactive bladder (OAB), specifically the use of sacral neuromodulation (SNM). A search was performed on the available literature on SNM and lower urinary tract dysfunction. Based on published studies available and also on personal experience, the treatment options for neurogenic OAB are reviewed, and specifically, the role for SNM in these patients is discussed. SNM is FDA-approved for patients with urge incontinence, urgency/frequency, and non-obstructive urinary retention. It involves stimulation of the third sacral nerve with an electrode implanted in the sacral foramen and connected to a pulse generator. The procedure is minimally invasive and is effective in about 70 % of patients who have a permanent system. The original trials leading to the approval of SNM excluded patients with neurogenic disease, as it was felt that intact spinal pathways were necessary for neuromodulation to occur. However, similar success rates have been observed in patients with neurogenic OAB. Special considerations for SNM use in patients with neurogenic OAB include recognizing that it is incompatible for patients who will need MRI’s due to their progressive neurologic disease. Many treatment options are available for patients with neurogenic OAB. First-line approaches remain conservative with lifestyle changes and anticholinergic medications. SNM has been used successfully in this patient population with good results, though larger randomized trials are lacking.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Tanagho EA, Schmidt RA, Orvis BR. Neural stimulation for control of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders. J Urol. 1989;142:340–5.

    PubMed  CAS  Google Scholar 

  2. Van Kerrebroeck PE, Marcelissen TA. Sacral neuromodulation for lower urinary tract dysfunction. World J Urol. 2011.

  3. Thompson JH, Sutherland SE, Siegel SW. Sacral neuromodulation: therapy evolution. Indian J Urol. 2010;26(3):379–84.

    Article  PubMed  Google Scholar 

  4. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167–78.

    Article  PubMed  Google Scholar 

  5. Aizenberg D, Sigler M, et al. Anticholinergic burden and the risk of falls among elderly psychiatric inpatients: a 4 year case control study. Int Psychogeriatr. 2002;14:307–10.

    Article  PubMed  Google Scholar 

  6. Kumar SPV, Abrams PH. Detrusor myectomy: long-term results with a minimum follow-up of 2 years. BJU International. 2005;96:341–4.

    Article  PubMed  Google Scholar 

  7. Stohrer M, Kramer G, Goepel M, Lochner-Ernst D, Kruse D, Rubben H. Bladder autoaugmentation in adult patients with neurogenic voiding dysfunction. Spinal Cord. 1997;35:456–62.

    Article  PubMed  CAS  Google Scholar 

  8. Stohrer M, Kramer G, Goepel M, et al. Bladder auto-augmentation in adult neurogenic bladder: long term follow-up. J Urol. 2000;163:224A.

    Google Scholar 

  9. Hasan ST, Marshall C, Robson WA, Neal DE. Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction. Br J Urol. 1995;76:551–7.

    Article  PubMed  CAS  Google Scholar 

  10. Erbguth FJ. Historical notes on botulism, clostridium botulinum, botulinum toxin, and the idea of the therapeutic use of the toxin. Mov Disord. 2004;19:S2–6.

    Article  PubMed  Google Scholar 

  11. Simpson LL. Molecular pharmacology of botulinum toxin and tetanus toxin. Annu Rev Pharmacol Toxicol. 1986;26:427–53.

    Article  PubMed  CAS  Google Scholar 

  12. Nitti VW. Botulinum toxin for the treatment of idiopathic and neurogenic overactive bladder: State of the art. Rev Urol. 2006;8:198–208.

    PubMed  Google Scholar 

  13. Schurch B, de seze M, Denys P, et al. 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. 2005;174(1):196–200.

    Article  PubMed  CAS  Google Scholar 

  14. • Herschorn S, Gajewski J, et al. Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence: a randomized, double-blind trial. J Urol. 2011;185(6):2229–35. This is a prospective, double-blind, placebo-controlled, randomized trial which demonstrated Botox is efficacious and safe in patients with neurogenic detrusor overactivity and urinary incontinence. Clinical benefit was seen for up to 9 months.

    Article  PubMed  CAS  Google Scholar 

  15. • Cruz F, Herschorn S, et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol. 2011;60(4):742–50. This is a prospective, double-blind, placebo-controlled, randomized trial which demonstrated Botox is efficacious and safe in patients with neurogenic detrusor overactivity and urinary incontinence. Botox reduced incontinence episodes and improved QOL in MS and SCI patients with NDO. The median time to request for re-treatment was 42 weeks.

    Article  PubMed  CAS  Google Scholar 

  16. Hassouna MM, Siegel SW, et al. Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety. J Urol. 2000;163(6):1849–54.

    Article  PubMed  CAS  Google Scholar 

  17. Siegel SW, Catanzaro F, Dijkema HE, et al. Long-term results of a multicenter study on sacral nerve stimulation for treatment of urinary urge incontinence, urgency-frequency, and retention. Urology. 2000;56:87–91.

    Article  PubMed  CAS  Google Scholar 

  18. Bosch JL, Groen J. Sacral nerve neuromodulation in the treatment of patients with refractory motor urge incontinence: long-term results of a prospective longitudinal study. J Urol. 2000;163:1219–22.

    Article  PubMed  CAS  Google Scholar 

  19. Dasgupta R, Wiseman OJ, Kitchen N, et al. Long-term results of sacral neuromodulation for women with urinary retention. BJU Int. 2004;94:335–7.

    Article  PubMed  Google Scholar 

  20. Sutherland SE, Lavers A, Carlson A, et al. Sacral nerve stimulation for voiding dysfunction: one institution’s 11-year experience. Neurourol Urodyn. 2007;26:19–28.

    Article  PubMed  Google Scholar 

  21. van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol. 2007;178:2029–34.

    Article  PubMed  Google Scholar 

  22. Schmidt RA, Jonas U, Oleson KA, Janknegt RA, Hassouna MM, Siegel SW, et al. Sacral nerve stimulation for treatment of refractory urinary urge incontinence: sacral nerve stimulation study group. J Urol. 1999;162:352–7.

    Article  PubMed  CAS  Google Scholar 

  23. Weil EH, Ruiz-Cerdα JL, Eerdmans PH, Janknegt RA, Bemelmans BL, van Kerrebroeck PE. Sacral root neuromodulation in the treatment of refractory urinary urge incontinence: a prospective randomized clinical trial. Eur Urol. 2000;37:161–71.

    Article  PubMed  CAS  Google Scholar 

  24. Vasdev N, Biles BD, Sandher R, Hasan TS. The surgical management of the refractory overactive bladder. Indian J Urol. 2010;26:263–9.

    Article  PubMed  Google Scholar 

  25. Roguin A, Zviman MM, et al. Modern pacemaker and implantable cardioverter/defibrillator systems can be magnetic resonance imaging safe: in vitro and in vivo assessment of safety and function at 1.5 T. Circulation. 2004;110(5):475–82.

    Article  PubMed  Google Scholar 

  26. Martin ET. Can cardiac pacemakers and magnetic resonance systems coexist? Eur Heart J. 2005;26:325–7.

    Article  PubMed  Google Scholar 

  27. Gimbel K, Gimbel JR, Kanal E. Can patients with implantable pacemakers safely undergo magnetic resonance imaging? J Am Coll Cardiol. 2004;43:1325–7.

    Article  PubMed  Google Scholar 

  28. •• Kessler TM, La Framboise D, Trelle S, Fowler CJ, Kiss G, Pannek J, et al. Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and meta-analysis. Eur Urol. 2010;58(6):865–74. This is a review and meta-analysis of studies that assessed the efficacy and safety of SNM use in patients with neurogenic lower urinary tract dysfunction.

    Article  PubMed  Google Scholar 

  29. Wallace PA, Lane FL, Noblett KL. Sacral nerve neuromodulation in patients with underlying neurologic disease. Am J Obstet Gynecol. 2007;197(1):96e1–5.

    Google Scholar 

  30. Sahai A, Cortes E, et al. Neurogenic detrusor overactivity in patients with spinal cord injury: evaluation and management. Curr Urol Rep. 2011;12(6):404–12.

    Article  PubMed  Google Scholar 

  31. •• Sievert KD, Amend B, Gakis G, Toomey P, Badke A, Kaps HP, et al. Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury. Ann Neurol. 2010;67(1):74–84. This is a case series of 10 patients with complete spinal cord lesions who underwent early bilateral SNM implantation demonstrating promising results.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Aaron H. Lay & Anurag K. Das

Authors
  1. Aaron H. Lay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anurag K. Das
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aaron H. Lay.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lay, A.H., Das, A.K. The Role of Neuromodulation in Patients with Neurogenic Overactive Bladder. Curr Urol Rep 13, 343–347 (2012). https://doi.org/10.1007/s11934-012-0272-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-012-0272-y

Keywords

Search

Navigation