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Neuromodulation by implant for treating lower urinary tract symptoms and dysfunction
B L Bemelmans1, A R Mundy, M D Craggs
1Department of Urology, University Hospital Nijmegen, The Netherland. b.bemelmans@uro.azn.nl
European Urology
|July 27, 1999
Summary
Sacral nerve stimulation, a form of therapeutic neuromodulation, offers a viable treatment for refractory lower urinary tract symptoms like incontinence and retention. Success rates range from 50-70%, with specific patient groups showing better outcomes.
Area of Science:
- Urology
- Neurology
- Medical Devices
Background:
- Lower urinary tract symptoms (LUTS) such as irritative micturition, pelvic pain, and urinary incontinence can be challenging to treat with conservative measures.
- Surgical interventions are often considered when non-invasive treatments fail, but carry inherent risks.
- Direct sacral nerve stimulation presents a therapeutic alternative for managing refractory LUTS.
Purpose of the Study:
- To review the therapeutic application of implantable neuromodulation for treating lower urinary tract symptoms and dysfunction.
- To explore the physiological basis, implantation techniques, and clinical outcomes of sacral nerve stimulation.
- To discuss future developments and potential improvements in neuromodulation therapy.
Main Methods:
- Comprehensive review of the international scientific literature on sacral nerve stimulation.
- Analysis of studies covering physiological mechanisms, acute testing, and chronic implantation procedures.
- Evaluation of reported clinical results and success rates.
Main Results:
- Neuromodulation likely functions by re-establishing a balanced interplay of excitatory and inhibitory impulses between pelvic organs and the sacral nervous system.
- Success rates for definitive implants typically range from 50% to 70%, depending on defined success criteria.
- Patients experiencing urge incontinence and urinary retention appear to be the most suitable candidates for neuromodulation therapy.
- A notable lack of standardization in patient selection, stimulation parameters, and success definitions was observed across the literature.
Conclusions:
- Implantable neuromodulation is an effective therapeutic option for specific lower urinary tract conditions.
- It should be considered for patients with therapy-resistant urge incontinence and urinary retention prior to surgical consideration.
- Future research should focus on clarifying the underlying physiology, standardizing methodologies, advancing technical aspects, and refining patient selection criteria.