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Related Concept Videos

The Micturition Reflex01:26

The Micturition Reflex

635
Urination, or micturition involves the coordination of the bladder's detrusor muscle and two sphincters to ensure controlled bladder emptying.
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating...
635

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Sacral Neuromodulation for Neurogenic Lower Urinary Tract Dysfunction.

Martina D Liechti1, Stéphanie van der Lely1, Stephanie C Knüpfer1,2

  • 1Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.

NEJM Evidence
|February 6, 2024
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Summary
This summary is machine-generated.

Sacral neuromodulation (SNM) effectively treats neurogenic lower urinary tract dysfunction (NLUTD) in selected patients. This study showed SNM significantly improved symptoms compared to baseline, even when stimulation was turned off.

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Area of Science:

  • Neurology
  • Urology
  • Biomedical Engineering

Background:

  • Neurogenic lower urinary tract dysfunction (NLUTD) is a common and debilitating condition with often unsatisfactory standard treatments.
  • Sacral neuromodulation (SNM) is established for non-NLUTD, but robust evidence from randomized controlled trials is lacking for NLUTD patients.
  • Refractory NLUTD poses a significant challenge, necessitating advanced therapeutic options.

Purpose of the Study:

  • To evaluate the efficacy of sacral neuromodulation (SNM) in patients with refractory neurogenic lower urinary tract dysfunction (NLUTD).
  • To compare the success rate of continuous SNM versus intermittent SNM in managing NLUTD.
  • To assess the durability of SNM effects in patients with NLUTD.

Main Methods:

  • A sham-controlled, double-blind, multicenter trial involving patients with refractory NLUTD.
  • Patients underwent SNM testing, with successful candidates receiving permanent neurostimulator implantation and optimized subsensory stimulation.
  • Participants were randomized to either SNM ON or SNM OFF groups for 2 months to assess sustained effects.

Main Results:

  • Of 124 patients tested, 65 (52%) showed improved lower urinary tract function, with 60 randomized.
  • The SNM ON group achieved a 76% success rate, while 42% in the SNM OFF group maintained benefits, indicating sustained effects (OR=4.35, P=0.009).
  • The study reported 11 adverse events, with no dropouts during the intervention phase.

Conclusions:

  • Sacral neuromodulation (SNM) demonstrates short-term efficacy in correcting refractory neurogenic lower urinary tract dysfunction (NLUTD) in well-selected neurological patients.
  • SNM offers a viable treatment option for NLUTD, with potential for sustained benefits even after deactivation.
  • Further research may explore long-term outcomes and optimal stimulation parameters for SNM in NLUTD.