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Sapouna V, Zikopoulos A, Thanopoulou S, Zachariou D, Giannakis I, Kaltsas A, Sopheap B, Sofikitis N, Zachariou A. Posterior Tibial Nerve Stimulation for the Treatment of Detrusor Overactivity in Multiple Sclerosis Patients: A Narrative Review. J Pers Med 2024; 14:355. [PMID: 38672982 PMCID: PMC11050849 DOI: 10.3390/jpm14040355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder dysfunction, particularly neurogenic detrusor overactivity (DO), poses a substantial challenge in multiple sclerosis (MS) patients, detrimentally impacting their quality of life (QoL). Conventional therapies often fall short, necessitating alternative approaches like posterior tibial nerve stimulation (PTNS) for effective management. This narrative review critically examines the application of PTNS in treating DO among MS patients, aiming to provide a comprehensive synthesis of its efficacy, underlying mechanisms, and clinical outcomes. By evaluating a spectrum of studies, including randomized controlled trials and long-term follow-up research, the review elucidates PTNS's role in enhancing bladder control and ameliorating symptoms of urgency and incontinence, thereby improving patient well-being. Despite its potential, the review acknowledges the limited scope of existing research specific to MS-induced neurogenic DO and calls for further investigation to optimize PTNS protocols and understand its long-term benefits. Highlighting PTNS's minimal invasiveness and favorable safety profile, the review advocates for its consideration as a viable third-line treatment option in MS-related bladder dysfunction management. Through this analysis, the review contributes to the broader narrative of seeking effective, patient-centered therapeutic strategies for MS-related complications, underscoring the importance of personalized care in improving patient outcomes.
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Affiliation(s)
- Vaia Sapouna
- Department of Urology, EV PRATTEIN Rehabilitation Centre, 38222 Volos, Greece; (S.T.); (D.Z.)
| | - Athanasios Zikopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (I.G.); (N.S.); (A.Z.)
| | - Sofia Thanopoulou
- Department of Urology, EV PRATTEIN Rehabilitation Centre, 38222 Volos, Greece; (S.T.); (D.Z.)
| | - Dimitrios Zachariou
- Department of Urology, EV PRATTEIN Rehabilitation Centre, 38222 Volos, Greece; (S.T.); (D.Z.)
| | - Ioannis Giannakis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (I.G.); (N.S.); (A.Z.)
| | - Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Bou Sopheap
- Department of Urology, Cambodia-China Friendship Preah Kossamak Hospital, Phnom Penh 120406, Cambodia;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (I.G.); (N.S.); (A.Z.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (I.G.); (N.S.); (A.Z.)
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Tahmasbi F, Salehi-Pourmehr H, Naseri A, Ghaderi S, Javadi-Farid F, Hajebrahimi S, Sedigh O, Soleimanzadeh F. Effects of posterior tibial nerve stimulation (PTNS) on lower urinary tract dysfunction: An umbrella review. Neurourol Urodyn 2024; 43:494-515. [PMID: 38153131 DOI: 10.1002/nau.25343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/26/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Lower urinary tract dysfunction (LUTD) is a common, troublesome condition that often negatively affects patients' quality of life. Current literature has long been interested in how posterior tibial nerve stimulation (PTNS) can affect this condition. AIM To extensively and systematically explore how PTNS affects LUTD based on the most recent systematic reviews. METHODS A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the systematic reviews, with or without meta-analysis that assessed the effects of PTNS on LUTD were retrieved. The quality of the included studies was assessed using the Joanna Briggs Institute tool, and analysis was conducted using the Comprehensive Meta-Analysis version 3 tool. RESULTS From a total of 3077 citations, 20 systematic reviews entered this study, and 13 of them included meta-analysis. The population of studies varied vastly, for instance, some studies included only children or women while other focused on a specific pathology like multiple sclerosis-induced neurogenic LUTD. The majority of included studies reported an overall improvement in LUTD following percutaneous PTNS, although admitting that these results were derived from moderate to low-quality evidence. CONCLUSION The findings of this thorough umbrella review showed that the positive benefits of PTNS in treating LUTD are currently supported by low-quality evidence, and it is crucial to interpret them with great care.
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Affiliation(s)
- Fateme Tahmasbi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Javadi-Farid
- Department of Urology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Omid Sedigh
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo Hospital, Torino, Italy
| | - Farzin Soleimanzadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Sevim M, Alkiş O, Kartal İG, Kazan HO, İvelik Hİ, Aras B, Kabay Ş. Comparison of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain syndrome: A randomized prospective trial. Prostate 2023; 83:751-758. [PMID: 36871235 DOI: 10.1002/pros.24513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a heterogenous condition that impacts the Quality of life severely, and it has multimodal complex treatment options. We aimed to compare the efficacy of two well-described neuromodulation therapies, transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in the treatment of category IIIB CP/CPPS. METHODS This study was designed as a randomized prospective clinical trial. We randomized category IIIB CP/CPPS patients into two treatment groups as TTNS and PTNS groups. Category IIIB CP/CPPS was diagnosed by two or four-glass Meares-Stamey test. All patients included in our study were antibiotic/anti-inflammatory resistant. Transcutaneous and percutaneous treatments were applied 30 min sessions for 12 weeks. Patients were evaluated by Turkish-validated National Health Institute Chronic Prostatitis Symptom Index (NIH-CPSI) and visual analogue scale (VAS) initially and after treatment. Treatment success was evaluated within each group and also compared with each other. RESULTS A total of 38 patients in the TTNS group and 42 patients in the PTNS group were included in the final analysis. The mean VAS scores of the TTNS group were lower than the PTNS group initially (7.11 and 7.43, respectively), (p = 0.03). The pretreatment NIH-CPSI scores were similar between groups (p = 0.07). VAS scores, total NIH-CPSI, NIH-CPSI micturation, NIH-CPSI pain, and NIH-CPSI QoL scores decreased significantly at the end of the treatment in both groups. We found a significantly higher VAS and NIH-CPSI scores decrease in the PTNS group compared to the TTNS group (p < 0.01). CONCLUSION Both PTNS and TTNS are effective treatment methods in category IIIB CP/CPPS. Comparing the two methods, PTNS provided a higher level of improvement in terms of pain and quality of life.
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Affiliation(s)
- Mehmet Sevim
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Okan Alkiş
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - İbrahim Güven Kartal
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Huseyin Ozgur Kazan
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Halil İbrahim İvelik
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Bekir Aras
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Şahin Kabay
- Department of Urology, Faculty of Medicine, Altinbas University, Istanbul, Turkey
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Marzouk MH, Darwish MH, El-Tamawy MS, Morsy S, Abbas RL, Ali AS. Posterior tibial nerve stimulation as a neuromodulation therapy in treatment of neurogenic overactive bladder in multiple sclerosis: A prospective randomized controlled study. Mult Scler Relat Disord 2022; 68:104252. [PMID: 36274285 DOI: 10.1016/j.msard.2022.104252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND one of the major annoying disorders occurring in people with multiple sclerosis is lower urinary tract disorders (LUT). Urgency is considered the main one seriously influencing the quality of life. Neurogenic detrusor over activity (DOAB) is characterized by a hyperreflexic, overactive detrusor that responds quickly to low-intensity sensory input from general visceral afferent fibers. Overactivity has been claimed to induce random, uncontrolled contractions of the detrusor muscle, leading to intravesicular pressure rise, producing urgency, frequency, and consequently incontinence AIM: To demonstrate the therapeutic efficacy for posterior tibial nerve stimulation (PTNS) in neurogenic over active bladder (NOAB) in people with multiple sclerosis METHODS: The current trial is a prospective, randomized controlled study. Forty remitting relapsing males with MS with moderate NOAB symptoms were randomly assigned into two equal groups; control group (C) treated by selected therapeutic exercises program for strengthening pelvic floor muscles and an intervention group (ES) receiving an additional posterior tibial nerve electrical stimulation. Each session ranged from 45- 50 minutes, three days weekly for a month. Outcome measures were recorded before starting the treatment and after termination of the study intervention and included over active bladder symptoms score (OVBS) score, urodynamic parameters (uroflow, filling and voiding cystometry), and post voiding residual volume by abdominal ultrasound RESULTS: There was a significant improvement of all voiding parameters compared to baseline and the group C except frequency of urgency incontinence. A significant decrease was detected in post-treatment mean episodes number of nighttime frequency, urgency, urgency incontinence (1.65 ± 0.93, 1.2 ± 0.52 and 1.5 ± 0.76) respectively of the ES group compared to that of group C (3.05 ± 1.09, 2.25 ± 0.71 and 2.25 ± 1.06) (P < 0.01). There was a significant decrease in median post-treatment OVBS score 3 (3-3) compared to group C median score 5 (6-4). A statistically significant improvement was observed of all urodynamic parameters (bladder capacity and compliance, Detrusor overactivity (DO), maximum flow rate and post voidal residual volume in the ES group compared to the group C CONCLUSION: PTNS is a promising and potentially beneficial treatment option for NOAB symptoms in males with MS and superior to pelvic floor muscle training alone.
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Affiliation(s)
- Mohamed H Marzouk
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
| | - Moshera H Darwish
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
| | | | - Samer Morsy
- Department of Urology, Faculty of Medicine, Cairo University.
| | - Rami L Abbas
- Physical Therapy Department, Beirut Arab University.
| | - Ahmed S Ali
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
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Atak Çakir P, Mutluay F, Hanoğlu L, Güzelburç V. Effect of transcutaneous posterior tibial nerve stimulation and repetitive transcranial magnetic stimulation on neurogenic overactive bladder symptoms in female patients with multiple sclerosis: The study protocol of a randomized controlled study. Front Neurol 2022; 13:1011502. [PMID: 36388236 PMCID: PMC9650967 DOI: 10.3389/fneur.2022.1011502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/28/2022] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION Neurogenic bladder is frequently seen in patients with multiple sclerosis (MS). Electrical stimulation methods (neuromodulation) can be used for patients that have persistent symptoms despite pharmacological treatment. This study aims to compare the effects of two different neuromodulation techniques used in the treatment of neurogenic bladder. METHODS AND ANALYSIS This is a single-center randomized controlled trial for MS patients with neurogenic bladder. Patients determined to be eligible according to the study criteria will be randomized into two treatment groups: the transcutaneous posterior tibial nerve stimulation (PTNS) and repetitive transcranial magnetic stimulation (rTMS) groups. Each group will include eight patients. The patients will be treated for a total of 10 sessions for two consecutive weeks. The pressure-flow study will be used to compare the initial and final urodynamic results as the primary outcome. All the participants will fill in a 3-day bladder diary before and after the treatments in each group. Patients will also be asked to complete specific questionnaires for incontinence and quality of life (QOL): Overactive Bladder Questionnaire-V8 score (OAB-V8), Incontinence Severity Index (ISI), Incontinence Quality of Life Scale score (I-QOL), International Incontinence Questionnaire (ICIQ-SF) score, and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) score) as the secondary outcomes. ETHICS AND DISSEMINATION An ethical approval number was obtained from the Non-Invasive Clinical Research Ethics Committee of Istanbul Medipol University (ethical approval number: 768). Support was received within the scope of the Istanbul Medipol University Scientific Research Project with project number 2020-2017. The result of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION NCT05312138.
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Affiliation(s)
- Pinar Atak Çakir
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Fatma Mutluay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Lütfü Hanoğlu
- Neurology Department, Istanbul Medipol University, Istanbul, Turkey
| | - Vahit Güzelburç
- Urology Department, Istanbul Medipol University Hospital, Istanbul, Turkey
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Vecchio M, Chiaramonte R, DI Benedetto P. Management of bladder dysfunction in multiple sclerosis: a systematic review and meta-analysis of studies regarding bladder rehabilitation. Eur J Phys Rehabil Med 2022; 58:387-396. [PMID: 35102733 PMCID: PMC9980558 DOI: 10.23736/s1973-9087.22.07217-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the efficacy of rehabilitation programs for bladder disorders in patients with multiple sclerosis (MS) and to guide physicians in delineating therapeutic tools and programs for physiatrists, using the best current strategies. EVIDENCE ACQUISITION A search was conducted on PubMed, EMBASE, the Cochrane Library and Web of Science. Studies were eligible if they included adults with bladder disorders related to MS and described specific treatments of rehabilitation interest. The search identified 190,283 articles using the key words "multiple sclerosis" AND "rehabilitation" AND "urinary" OR "bladder," of which the reviewers analyzed 81 full-texts; 21 publications met the criteria and were included in the systematic review. EVIDENCE SYNTHESIS The systematic review identified the specific rehabilitation treatments reported in the current literature. The meta-analysis compared the scores and scales used to quantify bladder disorders due to MS, both before and after rehabilitation or in a comparison with a control group. CONCLUSIONS The present study suggests the need of a specific therapeutic protocol, based on the degree of disability and symptom complexity in patients with MS-related neurogenic lower urinary tract dysfunction (NLUTD). Particularly, the meta-analysis shows the effectiveness of peripheral tibial nerve stimulation (PTNS) and pelvic floor muscle training (PFMT) for neurogenic detrusor overactivity (NDO). However, the goal of physiotherapy is to treat incontinence without making urinary retention worse and vice-versa, reducing the loss of urine urgency, while ensuring the emptying of the bladder.
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Affiliation(s)
- Michele Vecchio
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy - .,Unit of Rehabilitation, Vittorio Emanuele Polyclinic, Catania, Italy -
| | - Rita Chiaramonte
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Wang CN, Chung DE. Neuromodulation for lower urinary tract symptoms in special populations. Neurourol Urodyn 2022; 41:1948-1957. [PMID: 35579275 DOI: 10.1002/nau.24954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023]
Abstract
AIMS Discuss the efficacy, safety, and future directions of neuromodulation in special populations of patients with neurological conditions. METHODS A literature review was done to find meta-analyses, review articles, studies, and case reports of the use of neuromodulation, either sacral neuromodulation or percutaneous tibial nerve stimulation, in patients with various neurological conditions of interest. RESULTS Sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) appear to be safe and effective in special neurological populations of patients with multiple sclerosis (MS), Parkinson's disease (PD), and spinal cord injury (SCI). The majority of publications are smaller retrospective case series. Outcomes appear similar to those seen in nonneurogenic patients but also partly depend on disability progression. Magnetic resonance imaging (MRI) compatibility has helped to improve eligibility for SNM in these special populations. CONCLUSIONS In a small number of studies, SNM and PTNS appear to be safe and effective in special neurological populations of patients with MS, PD, and SCI. MRI compatibility has helped to improve eligibility for SNM in these special populations. Studies looking at SNM are limited by a small number of subjects, lack of prospective trials, and selection bias. Larger, randomized studies with long-term follow up are needed to better predict response to SNM and PTNS in these populations.
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Affiliation(s)
- Connie N Wang
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
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Chen SF, Kuo HC. Interventional management and surgery of neurogenic lower urinary tract dysfunction in patients with chronic spinal cord injury: A urologist's perspective. Low Urin Tract Symptoms 2022; 14:132-139. [PMID: 35233967 DOI: 10.1111/luts.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) caused by spinal cord injury (SCI) is challenging for urologists. NLUTD not only affects the quality of life but also endangers the upper urinary tract of patients with chronic SCI. Considering that the bladder and urethral function change with time, regular follow-up of NLUTD is necessary, and any complication should be adequately treated. The first priority of bladder management in patients with chronic SCI manifesting NLUTD should be renal function preservation, followed by the normalization of lower urinary tract function. The quality of life should also be assessed. Patients who have a high risk for impaired renal function should be more frequently identified and investigated. Conservative treatment and pharmacological therapy should be started as early as possible. Intravesical or urethral injections of botulinum toxin A is an alternative treatment for refractory NLUTD. When surgical intervention is necessary, less invasive and reversible procedures should be considered first. Improving patients' quality of life and willingness to undergo bladder management is the most important aspect of treatment.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Astasio-Picado Á, García-Cano M. Neuromodulation of the Posterior Tibial Nerve for the Control of Urinary Incontinence. Medicina (B Aires) 2022; 58:medicina58030442. [PMID: 35334618 PMCID: PMC8955811 DOI: 10.3390/medicina58030442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/01/2022] Open
Abstract
Urinary incontinence is considered a health problem that both elderly and young people can suffer, most often elderly women. This problem can lead to difficulties in establishing social relationships and dependence, negatively affecting the quality of life of the people who suffer from it. To evaluate and analyze the studies that demonstrate the efficacy of interventions based on the neuromodulation of the posterior tibial nerve as a treatment for the control of urinary incontinence. The search period for articles focused on those published between March 2011 to March 2021, in five databases (Pubmed, Cochrane Library, Scielo, Google Academic and WOS) based on the clinical question, using the keywords derived from the DeCS and MeSH thesauri, combined with the Boolean operators “AND”, “NOT” and “OR”. The search was limited to publications from the last 10 years, in English and Spanish. After applying the selection criteria and evaluating the quality of the methodology, 5.28% (n = 27) of the 511 results were included with filters: 9 systematic reviews, 10 cohorts and 8 randomized controlled trials. After comparing the different articles, it was found that percutaneous stimulation of the tibial nerve is a suitable technique for treating overactive bladder. It is a promising technique in case of pelvic floor dysfunctions and effective for the control of urinary incontinence.
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Sartori AM, Salemi S, Hofer AS, Baumgartner V, Eberli D, Liechti MD, Schwab ME, Kessler TM. Early Transcutaneous Tibial Nerve Stimulation Acutely Improves Lower Urinary Tract Function in Spinal Cord Injured Rats. Neurotrauma Rep 2022; 3:15-26. [PMID: 35211695 PMCID: PMC8863914 DOI: 10.1089/neur.2021.0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the fact that a majority of patients with an injury to the spinal cord develop lower urinary tract dysfunction, only few treatment options are available currently once the dysfunction arises. Tibial nerve stimulation has been used in pilot clinical trials, with some promising results. Hence, we investigated whether the early application of transcutaneous tibial nerve stimulation in the animal model of spinal cord injured rats can prevent the development of detrusor overactivity and/or detrusor-sphincter-dyssynergia. Rats were implanted with a bladder catheter and external urethral sphincter electromyography electrodes. A dorsal over-hemisection, resulting in an incomplete spinal cord injury at the T8/9 spinal level, induced immediate bladder paralysis. One week later, the animals received daily tibial nerve or sham stimulation for 15 days. Effects of stimulation on the lower urinary tract function were assessed by urodynamic investigation. Measurements showed improvements of several key parameters of lower urinary tract function—in particular, non-voiding bladder contractions and intravesical pressure—immediately after the completion of the stimulation period in the stimulated animals. These differences extinguished one week later, however. In the dorsal horn of the lumbosacral spinal cord, a small significant increase of the density of C-fiber afferents layers I-II was found in the stimulated animals at four weeks after spinal cord injury. Tibial nerve stimulation applied acutely after spinal cord injury in rats had an immediate beneficial effect on lower urinary tract dysfunction; however, the effect was transitory and did not last over time. To achieve more sustainable, longer lasting effects, further studies are needed looking into different stimulation protocols using optimized stimulation parameters, timing, and treatment schedules.
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Affiliation(s)
- Andrea M. Sartori
- Institute for Regenerative Medicine, University of Zürich, and Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Souzan Salemi
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Anna-Sophie Hofer
- Institute for Regenerative Medicine, University of Zürich, and Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Valentin Baumgartner
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Eberli
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Martina D. Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin E. Schwab
- Institute for Regenerative Medicine, University of Zürich, and Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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van Merode NAM, Dawson S, Coulthard E, Henderson EJ, Rice CM, Rees J, Smith M, Strong E, Cotterill N, Huntley AL, Drake MJ. Assessment and Treatment of Nocturia in Neurological Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. Eur Urol Focus 2022; 8:33-41. [PMID: 35031351 DOI: 10.1016/j.euf.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Neurological disease can affect the rate of urine production and bladder storage function, increasing nocturia severity, with additional risks if mobility or cognition is impaired. OBJECTIVE To conduct a systematic review (SR) of nocturia in neurological diseases and achieve expert consensus for management in clinics without neurologist input. EVIDENCE ACQUISITION Four databases were searched from January 2000 to April 2020. A total of 6262 titles and abstracts were screened and 43 studies were included for full-text screening. Eleven of these met the inclusion criteria and two studies were identified through other sources. The nominal group technique (NGT) was used to develop consensus in panel comprising experts and public representation. EVIDENCE SYNTHESIS Thirteen studies (seven in Parkinson's disease, five in multiple sclerosis) were included, all undertaken in secondary care. Neurological disease severity was incompletely described, and nocturia severity was generally measured subjectively. NGT consensus supported basic neurological assessment, and the use of bladder diaries where neurological impairment permits. Treatments include pelvic-floor muscle training, review of medications, risk mitigation, improving bowel function, therapy for overactive bladder syndrome (if urgency is reported in association with nocturia episodes), treatment of postvoid residual and desmopressin according to licence. Measures to improve mobility and mitigate risk when using the toilet overnight should be considered. Multifactorial issues such as obstructive sleep apnoea and hypoventilation must be considered. CONCLUSIONS Nocturia in neurological disease is complex and lacks a robust evidence base, with very little research done in the primary care context. Guidance should be pragmatic, with reduction of risk a key requirement, until a multidisciplinary evidence base can be developed. PATIENT SUMMARY People with a neurological disease can suffer severe sleep disturbance because of the need to pass urine several times overnight (called nocturia). We looked at published research and found very little information to help general practitioners in managing this condition. We assembled a group of experts to develop practical approaches for assessing and treating nocturia in neurological disease.
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Affiliation(s)
| | - Shoba Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth Coulthard
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily J Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Older Person's Unit, Royal United Hospital NHS Foundation Trust Bath, Combe Park, Bath, UK
| | - Claire M Rice
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edward Strong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nikki Cotterill
- School of Health and Social Wellbeing, University of the West of England, Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Alyson L Huntley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK.
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12
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Guitynavard F, Mirmosayyeb O, Razavi ERVS, Hosseini M, Hosseinabadi AM, Ghajarzadeh M, Azadvari M. Percutaneous posterior tibial nerve stimulation (PTNS) for lower urinary tract symptoms (LUTSs) treatment in patients with multiple sclerosis (MS): A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 58:103392. [DOI: 10.1016/j.msard.2021.103392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
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13
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Andersen K, Kobberø H, Pedersen TB, Poulsen MH. Percutaneous tibial nerve stimulation for idiopathic and neurogenic overactive bladder dysfunction: a four-year follow-up single-centre experience. Scand J Urol 2021; 55:169-176. [PMID: 33635171 DOI: 10.1080/21681805.2021.1885486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Overactive bladder (OAB) affects hundreds of millions of people worldwide and has significant detrimental effects on quality-of-life. Percutaneous tibial nerve stimulation (PTNS) is endorsed in the European guidelines of Urology as second-line therapy - on par with pharmacological treatment for women with OAB. METHODS This prospective cohort study describes our clinical experience with PTNS in a daily outpatient clinic, on a consecutive cohort. The cohort of 116 patients was mixed; including both men and women with idiopathic (iOAB) and neurogenic (nOAB) overactive bladder. Patients were treated with a 12-week course of PTNS followed by monthly maintenance treatment. Data were collected during 4 years. RESULTS The most common indication for PTNS was OAB with urge incontinence (53%) followed by OAB-dry and nocturia (both 16%). One hundred and ten (95%) patients completed follow-up and 68 patients (62%) continued to maintenance treatment. A total of 68 patients reported an effect on PROM, BD and ICIQ-OAB, which is the same 62% that continue in maintenance PTNS. A significant decline was seen in overall ICIQ-OAB score, with a median drop from 87 to 54, a significant decline in overall frequency and nocturia on bladder diary and a shift in pad test group in 19% of the incontinence patients. CONCLUSION PTNS shows an equally significant effect on men as well as women both in the iOAB and nOAB subgroups in a daily outpatient clinic. In our opinion, PTNS should be a standard treatment option available at urological departments, where both men and women in both sub-groups could benefit from treatment. Further randomized studies focusing on men with iOAB are needed.
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Affiliation(s)
- K Andersen
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - H Kobberø
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - T B Pedersen
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - M H Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Institute, University of Southern Denmark, Odense, Denmark
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Kabay S, Kabay SC. The Sustained Therapeutic Effects of Percutaneous Posterior Tibial Nerve Stimulation in the Treatment of Neurogenic Lower Urinary Tract Symptoms in Patients with Parkinson's Disease: 24-months Clinical and Urodynamic Results. Urology 2021; 153:49-55. [PMID: 33561470 DOI: 10.1016/j.urology.2021.01.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the sustained therapeutic effect of percutaneous posterior tibial nerve stimulation (PTNS) treatment in Parkinson's disease patients with detrusor activity during 24 months. METHODS After 12 weeks therapy, PTNS was applied at 14-day intervals for 3 months, 21-day intervals for 3 months and 28-day intervals through 24 months. The patients completed a 3-day voiding diary and ICIQ-SF, OAB-V8, OAB-q SF questionnaires at 3rd, 6th, 9th,12th and 24th month. RESULTS A total of 76 patients were enrolled in the study. Of these 44 (57.9%) were men and 32 (42.1%) women. The differences of compared parameters at baseline and at the end of 24 months were as follows; daytime frequency decreased by 4.6 voids daily, urge incontinence decreased by 4.2 episodes daily, urgency episodes decreased by 6.2 episodes daily, nocturia decreased by 2.4 voids (P <.001) and voided volume improved by a mean of 71.4 cc (P <.05). When compared with baseline significant improvements were seen in the volume at the first involuntary detrusor contraction (1st IDCV), maximum cystometric capacity (MCC), maximal detrusor pressure at first involuntary detrusor contraction (1st IDC Pdetmax), maximal detrusor pressure at MCC (MCC Pdetmax), detrusor pressure at maximal flow (PdetQmax) and post-void residual volume (PVR) after PTNS treatment at 3, 12, 24 months (P <.001 for each) except maximal flow rate (Qmax) value (P ˃.05). CONCLUSIONS These results have demonstrated the significant improvements both on voiding and urodynamic parameters under PTNS treatment with a tapering protocol for during 24-months in Parkinson's disease with detrusor activity.
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Affiliation(s)
- Sahin Kabay
- Altinbas University Faculty of Medicine, Department of Urology Istanbul, Turkey.
| | - Sibel Canbaz Kabay
- Kutahya Health Sciences University, Faculty of Medicine, Department of Neurology Kutahya, Turkey
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15
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Sönmez R, Yıldız N, Alkan H. Efficacy of percutaneous and transcutaneous tibial nerve stimulation in women with idiopathic overactive bladder: A prospective randomised controlled trial. Ann Phys Rehabil Med 2021; 65:101486. [PMID: 33429090 DOI: 10.1016/j.rehab.2021.101486] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/19/2022]
Abstract
BACKGROUND Different studies have reported the efficacy of percutaneous tibial nerve stimulation (PTNS) and transcutaneous tibial nerve stimulation (TTNS) in treating idiopathic overactive bladder (OAB). However, no study has compared the effectiveness of PTNS and TTNS added to bladder training (BT) in idiopathic OAB. OBJECTIVE To compare the efficacy of PTNS and TTNS added to BT in women with idiopathic OAB. METHODS We randomised 60 women with idiopathic OAB into 3 groups. Group 1 (n=19) received BT, Group 2 (n=19) received PTNS in addition to BT, and Group 3 (n=20) received TTNS in addition to BT. PTNS and TTNS were performed 2 days a week, for 30 min a day, for a total of 12 sessions for 6 weeks. Patients were evaluated by incontinence severity (pad test), a 3-day voiding diary (frequency of voiding, incontinence episodes, nocturia and number of pads used), symptom severity, quality of life, treatment success (positive response rate), treatment satisfaction (Likert scale), discomfort level and preparation time for stimulation (sec). RESULTS At the end of treatment; severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads used, symptom severity and quality of life were significantly improved in Groups 2 and 3 versus Group 1 (p<0.0167). Treatment success and treatment satisfaction were higher in Groups 2 and 3 than Group 1 (p<0.001 and p<0.0167, respectively). Level of discomfort was lower, treatment satisfaction was higher and preparation time for stimulation was shorter in Group 3 than Group 2 (p<0.05). CONCLUSION Both the PTNS plus BT and TTNS plus BT were more effective than BT alone in women with idiopathic OAB. These 2 tibial nerve stimulation methods had similar clinical efficacy but with slight differences: TTNS had shorter preparation time, less discomfort level and higher patient satisfaction than PTNS.
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Affiliation(s)
- Rafet Sönmez
- Pamukkale University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Denizli, Turkey
| | - Necmettin Yıldız
- Pamukkale University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Denizli, Turkey.
| | - Hakan Alkan
- Pamukkale University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Denizli, Turkey
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16
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Wang M, Jian Z, Ma Y, Jin X, Li H, Wang K. Percutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J 2020; 31:2457-2471. [DOI: 10.1007/s00192-020-04429-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/01/2020] [Indexed: 01/16/2023]
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17
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Managing Urological Disorders in Multiple Sclerosis Patients: A Review of Available and Emerging Therapies. Int Neurourol J 2020; 24:118-126. [PMID: 32615673 PMCID: PMC7332813 DOI: 10.5213/inj.2040028.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/18/2020] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis (MS) is a progressive neurological autoimmune disease with a diverse range of urological symptomatology, and most MS patients experience 1 or more moderate to severe urinary symptoms, as well as bladder and/or sexual disorders. Urologists play the director's role in evaluating and treating these patients. Therefore, identifying the proper evaluation tools and the most suitable therapeutic options for specific patients requires a thorough understanding of this disease process.
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18
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Polat Dunya C, Tulek Z, Kürtüncü M, Panicker JN, Eraksoy M. Effectiveness of the transcutaneous tibial nerve stimulation and pelvic floor muscle training with biofeedback in women with multiple sclerosis for the management of overactive bladder. Mult Scler 2020; 27:621-629. [DOI: 10.1177/1352458520926666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Overactive bladder (OAB) is common in patients with multiple sclerosis (MS) with a limited number of treatment options. Objective: To investigate the effect of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on OAB symptoms in female MS patients. Methods: This study was conducted at the outpatient MS clinic in Istanbul. At baseline bladder diary, post-voiding residue (PVR), OAB, and Qualiveen Scales (QoL: Quality of Life; Siup: Specific Impact of Urinary Problems on QoL) were assessed. Patients were allocated to receive TTNS or PFMT daily for 6 weeks and reevaluated using the same tests. Results: Fifty-five patients (TTNS = 28, PFMT = 27) were included. Compared with baseline, both TTNS and PFMT groups improved in terms of OAB ( p = 0.0001, p = 0.0001), Qualiveen-siup ( p = 0.0001, p = 0.0001), Qualiveen-QoL ( p = 0.002, p = 0.006), PVR ( p = 0.0001, p = 0.21), frequency ( p = 0.0001, p = 0.69), nocturia ( p = 0.0001, p = 0.19), urgency ( p = 0.0001, p = 0.0001), and urge incontinence ( p = 0.0001, p = 0.0001). Between-group comparisons showed significant differences in 24-hour frequency ( p = 0.002) in favor of TTNS. Conclusion: Our study demonstrates the efficacy of both TTNS and PFMT for managing OAB symptoms in MS, associated with a significant impact on QoL, but did not show superiority of the methods. Further studies are needed to explore differences between these two non-invasive treatments.
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Affiliation(s)
- Cansu Polat Dunya
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeliha Tulek
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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19
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Lane GI, Mao-Draayer Y, Barboglio-Romo P, Clemens JQ, Gupta P, Dunn R, Qin Y, Cameron AP, Stoffel JT. A prospective observational cohort study of posterior tibial nerve stimulation in patients with multiple sclerosis: design and methods. BMC Urol 2020; 20:58. [PMID: 32460741 PMCID: PMC7251681 DOI: 10.1186/s12894-020-00629-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Posterior tibial nerve stimulation (PTNS) is a promising treatment for lower urinary tract symptoms (LUTS) in patients with MS. However, long term data focusing on PTNS impact on health-related quality of life (HRQOL), bowel and bladder symptoms are lacking. This paper describes a study protocol that examines the extended efficacy of PTNS on MS related bladder and bowel symptoms and resulting HRQOL. METHODS/DESIGN This is a single-centered, prospective, longitudinal, observational cohort study of patients with MS who suffer from LUTS and are refractory to two prior treatment modalities. Participants who have elected to pursue PTNS therapy for LUTS will be eligible. The primary outcome is the median number of urinary frequency and incontinence episodes on a 3-day voiding diary at 3, 12 and 24 months compared to baseline. Secondary outcome measures will include change in total AUA-SS, M-ISI, NBSS, SF-12, SSS and BCS scores from baseline The Expanded Disability Status Scale and magnetic resonance imaging will be evaluated at baseline and annually throughout the study. DISCUSSION This research protocol aims to expand on the existing literature regarding outcomes of PTNS in MS. Specifically, it will provide long term follow-up data on bladder, bowel, sexual and HRQOL outcomes. The completion of this study will provide longitudinal efficacy data of the impact of PTNS in MS patients. TRIAL REGISTRATION NCT04063852.
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Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA.
| | - Yang Mao-Draayer
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Paholo Barboglio-Romo
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Rod Dunn
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Yongmei Qin
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, 1500 East Medical Drive, Taubman Center 3875, Ann Arbor, MI, 48109, USA
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20
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Abstract
PURPOSE OF REVIEW To provide an overview of available electrical stimulation devices in neurogenic patients with lower urinary tract disease. RECENT FINDINGS It is advocated to do more studies in neurogenic patients as results seem promising and useful but most studies did not include neurogenic patients or neurogenic patients were not analyzed or reported separately. Most studies included a small heterogenous neurogenic group with multiple pathophysiologic origin focusing on effect of a treatment instead of results of a treatment in a specific neurogenic group. Neuromodulation or stimulation has the advantage that it acts on different organs, like bladder and bowel, so can treat neurogenic patients, who mostly suffer from multiple organ failure. SUMMARY Brindley procedure, sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) are available for a while already. The Brindley procedure (including sacral anterior root stimulation in combination with a rhizotomy of posterior sacral roots) is developed for selected spinal cord injury patient with a complete spinal injury, and has shown results for many years in neurogenic patients. An alternative to the rhizotomy is not established yet. SNM and PTNS are other modalities that are used in nonneurogenic patients, but are not yet indicated and much studied in neurogenic patients.
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21
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Haddad R, Denys P, Arlandis S, Giannantoni A, Del Popolo G, Panicker JN, De Ridder D, Pauwaert K, Van Kerrebroeck PE, Everaert K. Nocturia and Nocturnal Polyuria in Neurological Patients: From Epidemiology to Treatment. A Systematic Review of the Literature. Eur Urol Focus 2020; 6:922-934. [PMID: 32192920 DOI: 10.1016/j.euf.2020.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/12/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Nocturia is among the most common and bothersome lower urinary tract symptoms (LUTS), but there is no clear consensus on how to identify and manage this symptom in the neurological population. OBJECTIVE To systematically review the literature about nocturia in neurological patients. EVIDENCE ACQUISITION Studies were identified by electronic search of Cochrane and Medline databases. The studies were included if their participants had acquired neurological pathology among multiple sclerosis (MS), Parkinson's disease (PD), stroke, spinal cord injury (SCI), and reported data on the epidemiology, aetiology, diagnosis, or treatment of nocturia. An independent extraction of the articles was performed by two authors using predetermined datasets, including quality-of-study indicators. EVIDENCE SYNTHESIS A total of 132 studies were included; 46 evaluated the epidemiology of nocturia, 28 the possible aetiologies, 10 the diagnostic tools, and 60 the treatments. Nocturia prevalence ranged from 15% to 96% depending on the pathology and definition used. It was one of the most frequently reported LUTS in PD and stroke patients. Several validated questionnaires were found to screen for nocturia in this population. Causalities were numerous: LUT, renal, sleep, cardiovascular dysfunctions, etc. Treatments targeted these mechanisms, with an overall risk of bias assessed as high or serious. The highest level of evidence was seen in MS patients: pelvic floor muscle training, cannabinoids, and desmopressin were effective, but not melatonin. In stroke patients, transcutaneous sacral and transcutaneous tibial nerve stimulation (TTNS) improved nocturia; in PD patients, TTNS, solifenacin, and rotigotine did not. CONCLUSIONS Nocturia is highly prevalent in patients with neurological disorders. Causalities and treatments are not different from the general population, but are poorly studied in neurological patients. PATIENT SUMMARY In this report, we looked at the published studies about nocturia-the fact of waking to void during the hours of sleep-in patients with neurological diseases. We found that nocturia is very frequent in this population, that the causes are the same as in the general population but may be combined, and that treatments are also the same but have an overall weak level of evidence. We conclude that more research is needed on this topic.
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Affiliation(s)
- Rebecca Haddad
- Urology Department, Ghent University Hospital, Ghent, Belgium.
| | - Pierre Denys
- Neuro-Urology Unit, PMR Department, Université de Versailles Saint Quentin, APHP, Raymond Poincaré Hospital, Garches, France
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, Siena, Italy
| | - Giulio Del Popolo
- Neuro-Urology & Spinal Unit Department, Careggi University Hospital, Firenze, Italy
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Dirk De Ridder
- Urology, University Hospitals KU Leuven, Leuven, Belgium
| | - Kim Pauwaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | | | - Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
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22
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Medina-Polo J, Adot JM, Allué M, Arlandis S, Blasco P, Casanova B, Matías-Guiu J, Madurga B, Meza-Murillo ER, Müller-Arteaga C, Rodríguez-Acevedo B, Vara J, Zubiaur MC, López-Fando L. Consensus document on the multidisciplinary management of neurogenic lower urinary tract dysfunction in patients with multiple sclerosis. Neurourol Urodyn 2020; 39:762-770. [PMID: 31943361 DOI: 10.1002/nau.24276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/30/2019] [Indexed: 11/07/2022]
Abstract
AIM Neurogenic lower urinary tract dysfunction (NLUTD) is very common in multiple sclerosis (MS) patients. Early diagnosis and treatment are crucial to avoid irreversible damage and improve quality of life. Our aim was to develop recommendations to improve NLUTD identification in MS patients, along with their referral and management. METHODS A multidisciplinary group of 14 experts in the management of patients with MS and NLUTD (nine urologists, three neurologists, and two rehabilitators) was selected. A comprehensive review of the literature was undertaken and a set of recommendations was generated and submitted to a Delphi panel of 114 experts. Recommendations were presented according to the grade of agreement (GA). RESULTS Early diagnosis in asymptomatic patients with risk factors for complications is recommended (GA 94%). Postvoid residual volume should be measured if changes in urinary symptoms (GA 87%), preferably ultrasound-guided (GA 86%). Early referral to urologist is recommended if urinary incontinence (GA 91%), significant post-void residual volume (94%), quality of life impairment (GA 98%) and recurrent urinary infections (GA 97%). The initial evaluation should include physical examination (GA 99%) and urodynamics including cystometry (GA 89%), pressure-flow study (90%) and electromyography (GA 70%). The panel recommends multidisciplinary collaboration (GA 100%) with a rehabilitation specialist and trained nurses in the management of NLUTD (GA 99%). CONCLUSIONS Multidisciplinary management for patients with NLUTD due to MS is advised, including urologists, neurologists, rehabilitation, and nurses. Panel recommends early diagnosis with post-void residual volume in symptomatic patients before referring to urologist and urodynamics when referred.
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Affiliation(s)
- José Medina-Polo
- Urology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José María Adot
- Urology Service, Hospital Universitario de Burgos, Burgos, Spain
| | - Marta Allué
- Urology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Salvador Arlandis
- Urology Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Pedro Blasco
- Urology Service, Hospital Universitario Virgen de Valme, Seville, Spain
| | - Bonaventura Casanova
- Unitat de Nauroinmunologia, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jorge Matías-Guiu
- Neurology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Blanca Madurga
- Urology Service, Puerta del Mar University Hospital, Cádiz, Spain
| | - Edwin-Roger Meza-Murillo
- Centre d'Esclerosi Múltiple de Catalunya (CEM-cat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Breogán Rodríguez-Acevedo
- Centre d'Esclerosi Múltiple de Catalunya (CEM-cat), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jesús Vara
- Rehabilitation and Physical Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Luis López-Fando
- Servicio de Urología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Bhide AA, Tailor V, Fernando R, Khullar V, Digesu GA. Posterior tibial nerve stimulation for overactive bladder-techniques and efficacy. Int Urogynecol J 2019; 31:865-870. [PMID: 31853597 PMCID: PMC7210232 DOI: 10.1007/s00192-019-04186-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 11/13/2019] [Indexed: 01/16/2023]
Abstract
The ideal treatment for overactive bladder is still elusive. In those where medication fails to improve symptoms options include invasive treatments such as botulinum toxin-A, sacral neural stimulation or posterior tibial nerve stimulation. Scientific professional society guidelines advise percutaneous posterior tibial nerve stimulation as a third line treatment option only after multi-disciplinary team review as well as failure of both conservative and pharmacological management. The aim of this article is to review all techniques for tibial nerve stimulation and their efficacy.
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Affiliation(s)
- Alka A Bhide
- St Mary's Hospital, Imperial College NHS Trust, London, UK.
| | - Visha Tailor
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Ruwan Fernando
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Vik Khullar
- St Mary's Hospital, Imperial College NHS Trust, London, UK
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24
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Doherty S, Vanhoestenberghe A, Duffell L, Hamid R, Knight S. A Urodynamic Comparison of Neural Targets for Transcutaneous Electrical Stimulation to Acutely Suppress Detrusor Contractions Following Spinal Cord Injury. Front Neurosci 2019; 13:1360. [PMID: 31956301 PMCID: PMC6951414 DOI: 10.3389/fnins.2019.01360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/02/2019] [Indexed: 01/18/2023] Open
Abstract
Objectives To assess and compare the effect of transcutaneous Dorsal Genital Nerve Stimulation (DGNS), Tibial Nerve Stimulation (TNS), Sacral Nerve Stimulation (SNS), and Spinal Stimulation (SS) on Neurogenic Detrusor Overactivity (NDO) and bladder capacity in people with Spinal Cord Injuries (SCI). Materials and Methods Seven male participants with supra-sacral SCI were tested. Standard cystometry (CMG) was performed to assess bladder activity at baseline and with stimulation applied at each site. This was conducted over four separate sessions. All stimulation was monophasic, 15 Hz, 200 μS pulses and applied at maximum tolerable amplitude. Results were analysed against individual control results from within the same session. Results Dorsal Genital Nerve Stimulation increased bladder capacity by 153 ± 146 ml (p = 0.016) or 117 ± 201%. DGNS, TNS and SNS all increased the volume held following the first reflex contraction, by 161 ± 175, 46 ± 62, and 34 ± 33 ml (p = 0.016, p = 0.031, p = 0.016), respectively. SS results showed small reduction of 33 ± 26 ml (p = 0.063) from baseline bladder capacity in five participants. Maximum Detrusor Pressure before leakage was increased during TNS, by 10 ± 13 cmH2O (p = 0.031) but was unchanged during stimulation of other sites. DGNS only was able to suppress at least one detrusor contraction in five participants and reduced first peak detrusor pressure below 40 cmH2O in these 5. Continuous TNS, SNS, and SS produced non-significant changes in bladder capacity from baseline, comparable to conditional stimulation. Increase in bladder capacity correlated with stimulation amplitude for DGNS but not TNS, SNS or SS. Conclusion In this pilot study DGNS acutely suppressed detrusor contractions and increased bladder capacity whereas TNS, SNS, and SS did not. This is the first within individual comparison of surface stimulation sites for management of NDO in SCI individuals.
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Affiliation(s)
- Sean Doherty
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom.,London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Anne Vanhoestenberghe
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom
| | - Lynsey Duffell
- Aspire Centre for Rehabilitation Engineering and Assistive Technologies, University College London, London, United Kingdom
| | - Rizwan Hamid
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Sarah Knight
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, United Kingdom
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Abstract
The function of the lower urinary tract is mainly storage and voiding of urine, which is coordinated by the nervous system. Various diseases of the nervous system may cause neuro-urological symptoms. Neuro-urological symptoms depend on the localization of the disease and the extension of the neurological lesion. About 80% of multiple sclerosis (MS) patients have neuro-urological symptoms within 10 years after diagnosis. In addition, 10% of MS patients may even present with voiding dysfunction at disease onset. In this review, different types of neuromodulation are discussed. The available studies suggest that sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) may be helpful in the neuromodulation of MS-related overactive bladder symptoms. These techniques may not only decrease the severity of symptoms but also significantly improve the quality of life of affected patients. Exploring the role of implantable tibial nerve stimulation devices in patients with MS could open new doors in the management of urgency and urgency incontinence in this patient group.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Department of Urology, Uniklinik RWTH Aachen, Aachen, Germany/Society of Urological Research and Education (SURE), Heerlen, The Netherlands
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Feasibility of Self-administered Neuromodulation for Neurogenic Bladder in Spinal Cord Injury. Int Neurourol J 2019; 23:249-256. [PMID: 31607105 PMCID: PMC6790819 DOI: 10.5213/inj.1938120.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose To determine if self-administered transcutaneous tibial nerve stimulation (TTNS) is a feasible treatment option for neurogenic bladder among people with spinal cord injury (SCI) who utilize intermittent catheterization for bladder management. Methods Four-week observational trial in chronic SCI subjects performing intermittent catheterization with incontinence episodes using TTNS at home daily for 30 minutes. Those using anticholinergic bladder medications were given a weaning schedule to begin at week 2. Primary outcomes were compliance and satisfaction. Secondary outcomes included change in bladder medications, efficacy based on bladder diary, adverse events, and incontinence quality of life (I-QoL) survey. Results All 16 subjects who started the study completed the 4-week trial rating TTNS with high satisfaction and easy to use, without discomfort. Twelve of 14 patients (86%) using anticholinergic bladder medications reduced their dosage and maintained similar frequency and volumes of bladder catheterization and incontinence episodes. Bladder medication reduced by approximately 3.2 mg weekly (95% confidence interval, -5.9 to -0.4) and anticholinergic side effects of dry mouth and drowsiness decreased more than 1 level of severity from baseline (P=0.027, P=0.015, respectively). At 4 weeks, total I-QoL score improved by an average of 3.2 points compared to baseline in all domains. Conclusions This pilot trial suggests TTNS is feasible to be performed at home in people with chronic SCI. Participants were able to reduce anticholinergic medication dosage and anticholinergic side effects while maintaining continence, subsequently improving QoL scores. These results advocate for further randomized, controlled trials with longer duration and urodynamic evaluation to assess long-term efficacy.
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Coolen RL, Groen J, Blok B. Electrical stimulation in the treatment of bladder dysfunction: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:337-345. [PMID: 31572023 PMCID: PMC6750158 DOI: 10.2147/mder.s179898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/24/2019] [Indexed: 01/24/2023] Open
Abstract
The urinary bladder has two functions: urine storage and voiding. Clinically, two major categories of lower urinary tract symptoms can be defined: storage symptoms such as incontinence and urgency, and voiding symptoms such as feeling of incomplete bladder emptying and slow urinary stream. Urgency to void with or without incontinence is called overactive bladder (OAB). Slow urinary stream, hesitancy, and straining to void with the feeling of incomplete bladder emptying are often called underactive bladder (UAB). The underlying causes of OAB or UAB can be either non-neurogenic (also referred to as idiopathic) and neurogenic, for example due to spinal cord injury or multiple sclerosis. OAB and UAB can be treated conservatively by lifestyle intervention or medication. In the case that conservative treatment does not provide sufficient benefit, electrical stimulation can be used. Sacral neurostimulation or neuromodulation (SNM) is offered as a third-line therapy to patients with non-neurogenic OAB or UAB. In SNM, the third or fourth sacral nerve root is stimulated and after a test period, a neuromodulator is implanted in the buttock. Until recently only a non-rechargeable neuromodulator was approved for clinical use. However, nowadays, a rechargeable sacral neuromodulator is also on the market, with similar safety and effectiveness to the non-rechargeable SNM system. The rechargeable device was approved for full body 1.5T and 3T MRI in Europe in February 2019. Regarding neurogenic lower urinary tract dysfunction, electrical stimulation only seems to benefit a selected group of patients.
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Affiliation(s)
- R L Coolen
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
| | - J Groen
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
| | - Bfm Blok
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
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Pincus J, Rostaminia G, Chang C, Gafni‐Kane A, Goldberg RP. Factors associated with overactive bladder symptom improvement after 1 year of monthly percutaneous tibial nerve stimulation therapy. Neurourol Urodyn 2019; 38:1676-1684. [DOI: 10.1002/nau.24038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/06/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Joseph Pincus
- Department of Female Pelvic Medicine and Reconstructive SurgeryNorthShore University HealthSystem, University of Chicago Pritzker School of MedicineChicago Illinois
| | - Ghazaleh Rostaminia
- Department of Female Pelvic Medicine and Reconstructive SurgeryNorthShore University HealthSystem, University of Chicago Pritzker School of MedicineChicago Illinois
| | - Cecilia Chang
- NorthShore University HealthSystem Research InstituteEvanston Illinois
| | - Adam Gafni‐Kane
- Department of Female Pelvic Medicine and Reconstructive SurgeryNorthShore University HealthSystem, University of Chicago Pritzker School of MedicineChicago Illinois
| | - Roger P. Goldberg
- Department of Female Pelvic Medicine and Reconstructive SurgeryNorthShore University HealthSystem, University of Chicago Pritzker School of MedicineChicago Illinois
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Vaughan CP, Fitzgerald CM, Markland AD. Management of Urinary Incontinence in Older Adults in Rehabilitation Care Settings. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bastholm SK, Aadal L, Lundquist CB. Electrical stimulation on urinary symptoms following stroke: a systematic review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1472634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Centre, Hammel, Denmark
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Salatzki J, Liechti MD, Spanudakis E, Gonzales G, Baldwin J, Haslam C, Pakzad M, Panicker JN. Factors influencing return for maintenance treatment with percutaneous tibial nerve stimulation for the management of the overactive bladder. BJU Int 2019; 123:E20-E28. [PMID: 30552801 DOI: 10.1111/bju.14651] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify factors influencing return for maintenance percutaneous tibial nerve stimulation (PTNS) treatment after successful completion of a 12-week course of treatment for overactive bladder (OAB). PATIENTS AND METHODS Patients with OAB symptoms referred for PTNS treatment underwent 12 sessions of weekly PTNS treatment and were evaluated at baseline and week 12 using the International Consultation on Incontinence Questionnaire on OAB, the International Consultation on Incontinence Questionnaire on lower urinary tract symptom-related quality of life (ICIQ-LUTSqol) and a bladder diary (BD). Responders to treatment, evaluated using two patient-reported outcome measures, were invited to return for maintenance treatment when symptoms returned. A PTNS Service Evaluation Questionnaire was used to evaluate factors influencing return for maintenance treatment. RESULTS Seventy-three patients were evaluated (mean age 58.9 [±14.7] years, 72.6% women) and clustered into three groups: group 1 (n = 25) did not respond to 12 weekly sessions of PTNS treatment; group 2 (n = 17) responded to treatment but did not return for maintenance treatment and group 3 (n = 31) responded to treatment and returned for maintenance treatment. There were no significant differences in demographic characteristics, diagnosis, baseline symptom scores and BD variables among the three groups. Patients belonging to groups 2 and 3 experienced a significant improvement from baseline to week 12 in total OAB scores (group 2: -1.54 ± 1.85; group 3: -1.85 ± 2.28; P < 0.05); however, patients returning for maintenance treatment reported significant improvements specifically in nocturia (BD difference = -0.4 ± 0.7 [P < 0.05] and ICIQ-LUTSqol difference -0.48 ± 0.94 [P < 0.05]), and perceived benefits of the treatment with regard to their OAB symptoms compared to those not returning for maintenance treatment (difference between the two groups 25.6%; P = 0.030). Improvements in nocturia and perceived benefits predicted return for maintenance treatment based on a logistic regression analysis. Factors related to the need for repeat clinic visits, such as transportation, distance and time commitment, were not found to differ between the two groups. CONCLUSIONS Twelve-session weekly PTNS is a safe and effective treatment for OAB. Responders to treatment returning for maintenance PTNS more often reported significant improvements in nocturia and perceived benefits over time, compared to those not returning for maintenance treatment. The BD provides a more objective assessment of treatment outcome after PTNS treatment.
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Affiliation(s)
- Janek Salatzki
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK.,Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martina D Liechti
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Eleonora Spanudakis
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Gwen Gonzales
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Joanne Baldwin
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Mahreen Pakzad
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
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32
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Tibial Nerve and Sacral Neuromodulation in the Multiple Sclerosis Patient with Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0495-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stampas A, Korupolu R, Zhu L, Smith CP, Gustafson K. Safety, Feasibility, and Efficacy of Transcutaneous Tibial Nerve Stimulation in Acute Spinal Cord Injury Neurogenic Bladder: A Randomized Control Pilot Trial. Neuromodulation 2018; 22:716-722. [DOI: 10.1111/ner.12855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/05/2018] [Accepted: 07/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Argyrios Stampas
- Department of PM&RUTHealth at Houston Houston TX USA
- TIRR Memorial Hermann Houston TX USA
| | - Radha Korupolu
- Department of PM&RUTHealth at Houston Houston TX USA
- TIRR Memorial Hermann Houston TX USA
| | - Liang Zhu
- Biostatistics and Epidemiology Research Design CoreUTHealth at Houston Houston TX USA
| | | | - Kenneth Gustafson
- Case Western Reserve UniversityDepartment of Biomedical Engineering Cleveland OH USA
- Case Western Reserve UniversityDepartment of Urology Cleveland OH USA
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Sakakibara R. Neurogenic lower urinary tract dysfunction in multiple sclerosis, neuromyelitis optica, and related disorders. Clin Auton Res 2018; 29:313-320. [DOI: 10.1007/s10286-018-0551-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/23/2018] [Indexed: 01/29/2023]
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Hare N, Georgopoulos P, Philips KE, Johnson JE, Seary C, Panicker JN, Stevenson VL. Improvement in overactive bladder symptoms in patients using functional electrical stimulation of the common peroneal nerve for walking. Clin Rehabil 2018; 32:1357-1362. [PMID: 29909652 DOI: 10.1177/0269215518780974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Functional electrical stimulation is used to improve walking speed and reduces falls in people with upper motor neurone foot-drop. Following anecdotal observations of changes in bladder symptoms, an observational study was performed to explore this association further. DESIGN A total of 47 consecutive patients attending for setup with functional electrical stimulation during a six-month period were asked to complete a questionnaire assessing bladder symptoms (ICIQ-OAB (International Consultation on Incontinence Questionnaire Overactive Bladder)) at baseline and three months during routine appointments. SUBJECTS In all, 35 (75%) had multiple sclerosis and the other 12 subjects had a total of 9 diagnoses including 3 with stroke. Other conditions included cerebral palsy, motor neurone disease, hereditary spastic paraparesis, meningioma and spinocerebellar ataxias. RESULTS Improvement in overactive bladder symptoms was not significant in the whole cohort, however, was significant in patients with multiple sclerosis ( n = 35; mean change in ICIQ-OAB score 1.0, P = 0.043). Specifically, significant improvements were seen in urgency and urge incontinence in multiple sclerosis patients. There was a significant negative correlation of moderate strength within the multiple sclerosis cohort between baseline walking speed and subsequent change in ICIQ-OAB score (correlation coefficient of r = -0.40, P = 0.046). Thus, greater changes in bladder symptoms were seen with lower baseline walking speeds. CONCLUSION The results of this exploratory study suggest that functional electrical stimulation use does improve overactive bladder symptoms in people with multiple sclerosis. Further exploration is needed to study this association and explore whether the mechanism is similar to that of percutaneous tibial nerve stimulation, a recognized treatment for the overactive bladder.
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Affiliation(s)
- Nicola Hare
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Petros Georgopoulos
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kate E Philips
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joanne E Johnson
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Coralie Seary
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jalesh N Panicker
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.,2 Institute of Neurology, University College London, London, UK
| | - Valerie L Stevenson
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.,2 Institute of Neurology, University College London, London, UK
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de Wall LL, Heesakkers JP. Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome. Res Rep Urol 2017; 9:145-157. [PMID: 28861404 PMCID: PMC5565382 DOI: 10.2147/rru.s124981] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Overactive bladder syndrome (OAB) is a common condition affecting adults and children worldwide, resulting in a substantial economic and psychological burden. Percutaneous tibial nerve stimulation (PTNS) is derived from acupuncture used in Chinese traditional medicine and was first described in the early 1980s. It is a neuromodulation technique used to modulate bladder function and facilitate storage. Being a minimally invasive, easily applicable, but time-consuming treatment, future developments with implantable devices might be the solution for the logistical problems and economic burden associated with PTNS on the long term. This nonsystematic review provides a current overview on PTNS and its effectiveness in the treatment of OAB for both adults and children.
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Affiliation(s)
- Liesbeth L de Wall
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - John Pfa Heesakkers
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Tracey JM, Stoffel JT. Secondary and tertiary treatments for multiple sclerosis patients with urinary symptoms. Investig Clin Urol 2016; 57:377-383. [PMID: 27847911 PMCID: PMC5109793 DOI: 10.4111/icu.2016.57.6.377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis patients with refractory urinary symptoms after treatment with behavioral therapy and medications still have treatment options. Prior to starting treatments, baseline symptoms should be assessed and treatment goals thoroughly discussed. Catheterization, botulinum toxin, and reconstructive surgery all can play a role in improving both safety and quality of life for these patients. Newer modalities, such as neuromodulation, may also have an increasing role in the future as more data develop regarding efficacy. Risks need to be weighed against any perceived benefit and disease status before more aggressive therapy is initiated.
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Affiliation(s)
- James M Tracey
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Abstract
Nocturia is an extremely common condition that has major sequelae for affected patients. Through disruption of sleep, nocturia impairs quality of life and worsens health outcomes, and is associated with a variety of morbidities including diabetes, coronary artery disease, obstructive sleep apnoea, obesity, metabolic syndrome, and depression. Unsurprisingly, several studies have also linked nocturia with reduced survival. Nocturia is not simply a consequence of lower urinary tract disease; rather, it is a multifactorial disorder that is often a manifestation of an underlying renal or systemic disease. Through the use of the frequency volume chart, clinicians can accurately quantify nocturia and determine its aetiology. Evaluation of quality of life and sleep using simple measures is essential in order to assess the impact of nocturia on a patient. Numerous treatment options for nocturia exist, but most are associated with minor benefit or lack sufficient evidence supporting their use. By systematically analysing an individual's causes of nocturia, clinicians can design appropriate treatment strategies to most effectively treat this condition.
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Affiliation(s)
- Hasan Dani
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
| | - Ashanda Esdaille
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, New York 11226, USA
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