Summary
Sacral neuromodulation, namely the electrical stimulation of the sacral nerves has become an alternative treatment for cases of idiopathic bladder overactivity. The mechanism of action in this type of spinal cord modulation is only partially understood but it seems to involve stimulation of inhibitory interneurons. Temporary sacral nerve stimulation is the first step. It consists of the temporary application of neurostimulation as a diagnostic test in order to check the integrity of the sacral root and determine the best location for the implant. If the test stimulation is successful, a permanent device is implanted. In experienced hands, this is a safe procedure. When the patients are selected on the basis of sound criteria, more than three-quarters of them show a clinically significant improvement with a reduction in the frequency of incontinence episodes by more than 50%; however, the results vary according to each author’s method of evaluation. The application of this technique should be combined with careful follow-up and attentive adjustments of the stimulation parameters in order to optimize the coordination of activity between the neurological systems involved.
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References
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from standardisation sub-committee of the international continence society. Neurourol Urodyn 21: 167–178
Amarenco G, Ismael SS, Even-Schneider A, Raibaut P, Demaille-Wlodyka S, Parratte B, Kerdraon J (2003) Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169(6): 2210–2215
Blaivas JG (2001) Chronic sacral neuromodulation. J Urol 166: 546
BØ K, Berghmans LCM (2000) Nonpharmacologic treatments for overactive bladder-pelvic floor exercises. Urol 55S5A: 7–11
Bosch JLH, Groen J (2000) Sacral Nerve Neuromodulation in the Treatment of Patients with Refractory Motor Urge Incontinence: Long-Term Results of a Prospective Longitudinal Study. J Urol 163: 1219–1222
Bycroft JA, Craggs MD, Sheriff M, Knight S, Shah PJ (2004) Does magnetic stimulation of sacral nerve roots cause contraction or suppression of the bladder? Neurourol Urodyn 23(3): 241–245
Chartier-Kastler EJ, Bosch JL, Perrigot M, Chancellor MB, Richard F, Denys P (2000) Long-term results of sacral nerve stimulation (S3) for the treatment of neurogenic refractory urge incontinence related to detrusor hyperreflexia. J Urol 164: 1476–1480
De Groat WC, Araki I, Vizzard MA, Yoshiyama M, Yoshimura N, Sugaya K, Tai C, Roppolo JR (1998) Developmental and injury induced plasticity in the micturition reflex pathway. Behav Brain Res 92: 127–140
de Seze M, Wiart L, de Seze MP, Soyeur L, Dosque JP, Blajezewski S, Moore N, Brochet B, Mazaux JM, Barat M, Joseph PA (2004) Intravesical capsaicin versus resiniferatoxin for the treatment of Sacral neuromodulation 321 detrusor hyperreflexia in spinal cord injured patients: a doubleblind, randomized, controlled study. J Urol 171(1): 251–255
Elhilali MM, Khaled SM, Kashiwabara T, Elzayat E, Corcos J (2005) Sacral neuromodulation: long-term experience of one center. Urology 65(6): 1114–1117
Groen J, Amiel C, Bosch JL (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(3): 226–230
Hohenfellner M, Humke J, Hampel C, Dhams S, Matzel K, Roth S, Thuroff JW, Schultz-Lampel D (2001) Chronic sacral neuromodulation for treatment of neurogenic bladder dysfunction: Long-term results with unilateral implants. Urol 58: 887–892
Jamil F (2001) Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI). Spinal Cord 39(7): 355–361
Mostwin JL (2002) Pathophysiology: the varieties of bladder over-activity. Urology 60: 22–27
Schlote N, Tanagho EA (2002) Electrical stimulation of the lower urinary tract: historical overview. In: Jonas U, Grunewald V (eds) New perspectives in sacral nerve stimulation for control of lower urinary tract dysfunction. Martin Dunitz Ltd, London
Schmidt R, Jonas U, Oleson K, Janknegt RA, Hassouna MM, Siegel SW, Van Kerrebroeck PEV (1999) For the sacral nerve stimulation study group. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. J Urol 162: 352–357
Schurch B, de Seze M, Denys P, Chartier-Kastler E, Haab F, Everaert K, Plante P, Perrouin-Verbe B, Kumar C, Fraczek S, Brin MF (2005) Botox Detrusor Hyperreflexia Study Team. 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(1): 196–200
Seif C, van der Horst C, Naumann CM, Junemann KP, Bosch R, Buller J, Braun PM (2005) Pudendal nerve stimulation therapy of the overactive bladder, an alternative to sacral neuromodulation? Aktuelle Urol 36(3): 234–238
Spinelli M, Weil E, Ostardo E, Del Popolo G, Ruiz-Cerda JL, Kiss G, Heesakkers J (2005) New tined lead electrode in sacral neuromodulation: experience from a multicentre European study. World J Urol 23(3): 225–229
Tanagho EA, schmidt RA (1982) Bladder pacemaker: scientific basis and clinical future. Urol 20: 614–619
Vignes JR, De Seze M, Dobremez E, Joseph PA, Guérin J (2005) Sacral neuromodulation in lower urinary tract dysfunction. Advances and technical standards in neurosurgery, vol 30. Springer, Wien New York
Vodusek DB (1988) Detrusor inhibition on selective pudendal nerve stimulation in the perineum. Neurourol Urodyn 6: 389–393
Weil EH, Ruiz-Cerda JL, Eerdmans PH, Janknegt RA, Bemelmans BL, van Kerrebroeck PE (2000) Sacral root neuromodulation in the treatment of refractory urinary urge incontinence: a prospective randomized clinical trial. Eur Urol 37: 161–171
Yoshimura N (1999) Bladder afferent pathway and spinal cord injury: possible mechanisms inducing hyperreflexia of the urinary bladder. Prog in Neurobiol 57: 583–606
Zhou Y, Wang Y, Abdelhady M, Mourad MS, Hassouna MM (2002) Change of vanilloid receptor 1 following neuromodulation in rats with spinal cord injury. J Surg Res 107(1): 140–144
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Vignes, J.R., de Seze, M., Guerin, J., Barat, M. (2007). Sacral neuromodulation as a functional treatment of bladder overactivity. In: Sakas, D.E., Simpson, B.A., Krames, E.S. (eds) Operative Neuromodulation. Acta Neurochirurgica Supplements, vol 97/1. Springer, Vienna. https://doi.org/10.1007/978-3-211-33079-1_42
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DOI: https://doi.org/10.1007/978-3-211-33079-1_42
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