Current and future techniques of neuromodulation for bladder dysfunction.
Recent increase in the use of neuromodulation for the treatment of urinary urgency and frequency, urge incontinence, and nonobstructive urinary retention has coincided with improved knowledge of micturition physiology and concurrent technologic advances in nerve stimulation. Currently, the most common technology for bladder neuromodulation involves stimulation through the S3 foramen, or sacral neuromodulation, although other techniques of neuromodulation continue to be explored. Despite many advances in neuromodulation, the exact mechanism of action remains uncertain. Additionally, which patients will respond to neuromodulation remains unclear, and although there is a standard method for testing, this procedure is invasive and expensive. As we continue to improve patient selection criteria and better understand the mechanism of action, the efficacy and patient satisfaction should continue to increase. Currently, most patients considered for implantation with a neuromodulator are those unresponsive to other conservative treatments for bladder dysfunction.
Division of Urology, Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, 185 South Orange Avenue, MSB-534, Newark, NJ 07101, USA. shermane@umdnj.edu
Neil D
ND
Sherman
Cindy L
CL
Amundsen
D018856:Cystitis, Interstitial / Q000628:therapy; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation*; D014550:Urinary Incontinence, Stress / Q000628:therapy; D016055:Urinary Retention / Q000628:therapy; D014555:Urination Disorders / Q000175:diagnosis / Q000628:therapy*