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Neuromodulation Treatment of Underactive Bladder

  • Michael B. ChancellorEmail author

Abstract

While most clinicians know there is a lack of effective pharmacological treatment of the underactive bladder (UAB), not many physicians and nurses realize that there is a regulatory approved minimally invasive therapy for UAB. This technique is neuromodulation via sacral nerve stimulation (SNS).

The vanguard work of Tanagho and Schmidt in the 1980s led to the development of electrical stimulation of the sacral nerve roots to facilitate urination in cases of UAB or modulation detrusor overactivity in cases of urge incontinence. Neuromodulation offers the advantage of durable, consistent control of lower urinary tract function. This minimally invasive technology requires implantation of the electrode and pulse generator and will be described.

In addition to SNS, alternative neuromodulation methods including the Brindley device, bidirectional pudendal nerve stimulation and blockade, the nerve rerouting Xiao procedure, direct electrode stimulation of the detrusor wall, and indirect intravesical catheter-based electrostimulation will be presented in this chapter. Chapter 9 will present surgical methods to treat underactive bladder.

Keywords

Pudendal Nerve Sacral Nerve Stimulation Detrusor Contraction Sacral Neuromodulation Neurogenic Detrusor Overactivity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Aboseif S, Tamaddon K, Chalfin S et al (2002) Sacral neuromodulation in functional urinary retention: an effective way to restore voiding. BJU Int 90:662–665CrossRefPubMedGoogle Scholar
  2. Bertapelle P, Bodo G, Carone R (2008) Detrusor acontractility in urinary retention: detrusor contractility test as exclusion criteria for sacral neuromodulation. J Urol 180:215–216CrossRefPubMedGoogle Scholar
  3. Brindley GS (1994) The first 500 patients with sacral anterior root stimulator implants: general description. Paraplegia 32:795–805CrossRefPubMedGoogle Scholar
  4. Chancellor MB, Diokno A (2014) CURE-UAB: shedding light on the underactive bladder syndrome. Int Urol Nephrol 46(Suppl 1):S1CrossRefPubMedGoogle Scholar
  5. Datta SN, Chaliha C, Singh A et al (2008) Sacral neuromodulation for urinary retention: 10 year experience from one UK centre. BJU Int 101:192–196PubMedGoogle Scholar
  6. Decter RM, Snyder P, Laudermilch C (1994) Transurethral electrical bladder stimulation: a follow-up report. J Urol 152:812–817PubMedGoogle Scholar
  7. Decter RM (2000) Intravesical electrical stimulation of the bladder: con. Urology 56:5–8CrossRefPubMedGoogle Scholar
  8. de Groat WC (1997) Chapter 6. Central nervous system control of micturition. In: O’Donnell PD (ed) Urinary incontinence. Mosby Publisher, St. Louis, pp 33–47Google Scholar
  9. de Groat WC, Araki I, Vizzard MA, Yoshiyama M, Yoshimura N, Sugaya K, Tai C, Roppolo JR (1997) Developmental and injury induced plasticity in the micturition reflex pathway. Behav Brain Res 92:127CrossRefGoogle Scholar
  10. Ebner A, Jiang C, Lindstrom S (1992) Intravesical electrical stimulation—an experimental analysis of the mechanism of action. J Urol 148:920–924PubMedGoogle Scholar
  11. Fischer J, Madersbacher H, Zechberger J et al (1993) Sacral anterior root stimulation to promote micturition in transverse spinal cord lesions. Zentralbl Neurochir 54:77–79PubMedGoogle Scholar
  12. Goh M, Diokno AC (2007) Sacral neuromodulation for nonobstructive urinary retention—is success predictable? J Urol 178:197–199CrossRefPubMedGoogle Scholar
  13. Jonas U, Fowler CJ, Chancellor MB et al (2001) Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation. J Urol 165:15–19CrossRefPubMedGoogle Scholar
  14. Jonas U, Tanagho EA (1975) Studies on the feasibility of urinary bladder evacuation by direct spinal cord stimulation. II. Poststimulus voiding: a way to overcome outflow resistance. Invest Urol 13:151–153PubMedGoogle Scholar
  15. Kaplan WE (2000) Intravesical electrical stimulation of the bladder: pro. Urology 56:2–4CrossRefPubMedGoogle Scholar
  16. Kaplan WE, Richards TW, Richards I (1989) Intravesical transurethral bladder stimulation to increase bladder capacity. J Urol 142:600–602PubMedGoogle Scholar
  17. Leng WW, Chancellor MB (2005) How sacral nerve stimulation neuromodulation works. Urol Clin North Am 32:11–18CrossRefPubMedGoogle Scholar
  18. Lyne CJ, Bellinger MF (1993) Early experience with transurethral electrical bladder stimulation. J Urol 150:697–699PubMedGoogle Scholar
  19. Noblett KL, Cadish LA (2014) Sacral nerve stimulation for the treatment of refractory voiding and bowel dysfunction. Am J Obst Gyn 210:99–106CrossRefGoogle Scholar
  20. Peters KM, Feber KM, Bennett RC (2005) Sacral versus pudendal nerve stimulation for voiding dysfunction: a prospective, single-blinded, randomized, crossover trial. Neurourol Urodyn 24:643–647CrossRefPubMedGoogle Scholar
  21. Peters KM, Girdler B, Turzewski C, Trock G, Feber K, Nantau W, Bush B, Gonzalez J, Cass E, de Benito J, Diokno A (2010) Outcomes of lumbar to sacral nerve rerouting for spina bifida. J Urol 184:702–708CrossRefPubMedGoogle Scholar
  22. Pham K, Guralnick ML, O’Connor RC (2008) Unilateral versus bilateral stage I neuromodulatory lead placement for the treatment of refractory voiding dysfunction. Neurourol Urodyn 27:779–781CrossRefPubMedGoogle Scholar
  23. Possover M (2009) The sacral LION procedure for recovery of bladder/rectum/sexual functions in paraplegic patients after explanation of a previous Finetech-Brindley controller. J Minim Invasive Gynecol 16:98–101CrossRefPubMedGoogle Scholar
  24. Spinelli M, Giardiello G, Arduini A, van den Hombergh U (2003) New percutaneous technique of sacral nerve stimulation has high initial success rate: preliminary results. Eur Urol 43:70–74CrossRefPubMedGoogle Scholar
  25. Shaker HS, Hassouna M (1998) Sacral root neuromodulation in idiopathic nonobstructive chronic urinary retention. J Urol 159:1476CrossRefPubMedGoogle Scholar
  26. Tai CF, Roppolo JR, de Groat WC (2004) Block of external urethral sphincter contraction by high frequency electrical stimulation of pudendal nerve. J Urol 172:2069–2072CrossRefPubMedGoogle Scholar
  27. Tai CF, Wang J, Chancellor MB, Roppolo JR, de Groat WC (2008) Influence of temperature on pudendal nerve block induced by high frequency biphasic electrical current. J Urol 180:1173–1178PubMedCentralCrossRefPubMedGoogle Scholar
  28. Tanagho EA, Schmidt RA (1988) Electrical stimulation in the clinical management of the neurogenic bladder. J Urol 140:1331–1339PubMedGoogle Scholar
  29. Tanagho EA, Schmidt RA, Orvis BR (1989) Neural stimulation for control of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders. J Urol 142(2 Pt 1):340–346PubMedGoogle Scholar
  30. Thüroff JW (2011) Re: outcomes of lumbar to sacral nerve rerouting for spina bifida. Eur Urol 59:173–175CrossRefPubMedGoogle Scholar
  31. van Kerrebroeck PE, van der Aa HE, Bosch JL et al (1997) Sacral rhizotomies and electrical bladder stimulation in spinal cord injury. I. Clinical and urodynamic analysis. Dutch Study Group on Sacral Anterior Root Stimulation. Eur Urol 31:263–271PubMedGoogle Scholar
  32. van Kerrebroeck EV, Scheepens WA, de Bie RA, Weil EH (2005) European experience with bilateral sacral neuromodulation in patients with chronic lower urinary tract dysfunction. Urol Clin North Am 31:51–57CrossRefGoogle Scholar
  33. van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP et al (2007) Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol 178:2029–2034CrossRefPubMedGoogle Scholar
  34. Wein AJ, Barrett DM (1988) Voiding function and dysfunction—a logical and practical approach. Year Book, ChicagoGoogle Scholar
  35. White WM, Dobmeyer-Dittrich C, Klein FA, Wallace LS (2008) Sacral nerve stimulation for treatment of refractory urinary retention: long-term efficacy and durability. Urology 71:71–74CrossRefPubMedGoogle Scholar
  36. Xiao C (2006) Reinnervation for neurogenic bladder: historic review and introduction of a somatic-autonomic reflex pathway procedure for patients with spinal cord injury or spina bifida. Eur Urol 49:22–29CrossRefPubMedGoogle Scholar
  37. Xiao CG, de Groat WC, Godec CJ, Dai C (1999) Xiao Q: “Skin-CNS-bladder” reflex pathway for micturition after spinal cord injury and its underlying mechanisms. J Urol 162(3 Pt 1):936–942CrossRefPubMedGoogle Scholar
  38. Xiao CG, Du MX, Dai C, Li B, Nitti VW et al (2003) An artificial somatic-central nervous system-autonomic reflex pathway for controllable micturition after spinal cord injury: preliminary results in 15 patients. J Urol 170:1237–1241CrossRefPubMedGoogle Scholar
  39. Xiao CG, Du MX, Li B, Liu Z, Chen M et al (2005) An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida. J Urol 173:2112–2116CrossRefPubMedGoogle Scholar
  40. Yoshimura N, de Groat WS (1997) Neural control of the lower urinary tract. Int J Urol 4:111–125CrossRefPubMedGoogle Scholar
  41. Yoshimura N, Chancellor MB (2011) Physiology and pharmacology of the bladder and urethra. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (eds) Campbells urology, 10th edn Elsevier, Philadelphia, PA, USAGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Urology, Aikens Research CenterOakland University William Beaumont School of MedicineRochesterUSA
  2. 2.Neurourology ProgramBeaumont Health SystemRoyal OakUSA

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