Neurostimulation and Neuromodulation for the Treatment for the Underactive Bladder
Several electrical stimulation techniques are available for the treatment of the underactive bladder (UAB). The techniques available are applicable for different neurogenic situations such as the anterior sacral root stimulation after selective posterior
- PDF / 155,964 Bytes
- 5 Pages / 439.37 x 666.14 pts Page_size
- 26 Downloads / 263 Views
Neurostimulation and Neuromodulation for the Treatment for the Underactive Bladder J. Drossaerts, R. Jairam, G.A. van Koeveringe, and P.E.V. van Kerrebroeck
Key Points
• Several electrical stimulation techniques are available for the treatment of DU. • The anterior sacral root stimulator is an option to restore volitional voiding in patients with complete spinal cord injury but requires sufficient bladder contractility. • Sacral neuromodulation has established efficacy in patients with urinary retention but also requires sufficient contractility. • Transurethral electrotherapy is a promising less invasive option, but randomised studies are required to establish efficacy.
Introduction According to the ICS detrusor underactivity (DU) can be defined as a decreased strength or duration of detrusor contraction, preventing the timely and efficient emptying of the bladder [1]. The symptom complex of underactive bladder (UAB) has not been formally defined but is characterised by urinary symptoms including hesitancy, straining and incomplete bladder emptying in the absence of an anatomical obstruction. There are three possible mechanisms by which the UAB can develop [2–4]. Patients in whom the main cause is thought to be an age-related decrease in detrusor
J. Drossaerts, MD • R. Jairam, MD • G.A. van Koeveringe, MD, PhD P.E.V. Van Kerrebroeck, MD, PhD, MMSc (*) Department of Urology, Maastricht University Medical Center+, PO BOX 5800, Maastricht NL – 6202 AZ, The Netherlands e-mail: [email protected]; [email protected] © Springer International Publishing Switzerland 2017 C.R. Chapple et al. (eds.), Underactive Bladder, DOI 10.1007/978-3-319-43087-4_8
57
58
J. Drossaerts et al.
contractility can be labelled as having idiopathic UAB. It is hypothesised that this process has two phases where a decrease in detrusor strength is preceded by reduced detrusor contraction velocity [5]. The myogenic hypothesis is based on impairment of the bladder smooth muscle function due to an altered excitation-contraction coupling mechanism of the detrusor muscle cells and results in reduced intrinsic myogenic activity of the detrusor. In the neurogenic hypothesis UAB may result from changes in the efferent limb of the micturition reflex, the afferent signals initiating the reflex and the integrative control [4]. Since detrusor contraction and strength are a result of efferent nerve activity which is dependent on sensory input, impaired sensory function can also cause UAB. Patient with UAB are at risk for the development of chronic renal failure and urinary tract infections. These patients have to rely on an indwelling bladder catheter or clean intermittent catheterisation. Unfortunately effective oral drugs are lacking. Based on our knowledge on the neurophysiology and due to the development of electrical innovations, neurostimulation and neuromodulation have been clinically adopted in the treatment of UAB.
History of Electrical Bladder Stimulation The first electrical stimulation of the nerve, which resulted in muscle c
Data Loading...
