Neuromodulation for the Treatment of Lower Urinary Tract Symptoms

The objectives of this article are to review the mechanism of action, the type of neuromodulation, and the efficacy of neuromodulation mainly according to the results of randomized controlled trials. Neuromodulation includes pelvic floor electrical stimulation (ES) using vaginal, anal and surface electrodes, interferential therapy (IF), magnetic stimulation (MS), percutaneous tibial nerve stimulation, and sacral nerve stimulation (SNS). The former four stimulations are used for external periodic (short‐term) stimulation, and SNS are used for internal, chronic (long‐term) stimulation. All of these therapies have been reported to be effective for overactive bladder or urgency urinary incontinence. Pelvic floor ES, IF, and MS have also been reported to be effective for stress urinary incontinence. The mechanism of neuromodulation for overactive bladder has been reported to be the reflex inhibition of detrusor contraction by the activation of afferent fibers by three actions, i.e., the activation of hypogastric nerve, the direct inhibition of the pelvic nerve within the sacral cord and the supraspinal inhibition of the detrusor reflex. The mechanism of neuromodulation for stress incontinence is contraction of the pelvic floor muscles through an effect on the muscle fibers as well as through the stimulation of pudendal nerves. Overall, cure and improvement rates of these therapies for urinary incontinence are 30–50, and 60–90% respectively. MS has been considered t...
Source: LUTS: Lower Urinary Tract Symptoms - Category: Urology & Nephrology Authors: Tags: REVIEW ARTICLE Source Type: research

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Authors: Oliveira-Ferreira C, Leuzinger-Dias M, Tavares-Ferreira J, Silva SE, Brandão E, Falcão-Reis F, Rocha-Sousa A PMID: 31718366 [PubMed - as supplied by publisher]
Source: Ophthalmic Genetics - Category: Opthalmology Tags: Ophthalmic Genet Source Type: research
ConclusionsMirabegron efficacy, safety, and tolerability over 12 wk were confirmed in patients aged ≥65 yr with OAB and incontinence.Patient summaryWe examined the effect of mirabegron compared with placebo in people aged 65 yr or older with overactive bladder and incontinence. Mirabegron improved the symptoms of overactive bladder compared with placebo. Side effects were similar to those already known for mirabegron.
Source: European Urology - Category: Urology & Nephrology Source Type: research
Conclusion: Morse wavelets could be used to extract differences between pre- and post-initial contact activation behavior of PFMs during different running speeds as well as spectral changes toward high or low frequencies. This information sheds light on specific differences in involuntary reflexive activation patterns while running. Muscular preparation and adaptation a few milliseconds before initial contact could be helpful.
Source: Annals of Physical and Rehabilitation Medicine - Category: Rehabilitation Source Type: research
Kate V. Meriwether1*, Zhenmin Lei1, Rajbir Singh2, Jeremy Gaskins3, Deslyn T. G. Hobson1 and Venkatakrishna Jala2 1Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY, United States 2Department of Microbiology and Immunology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States 3Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, United States Interstitial cystitis/bladder pain syndrome (ICBPS) may be related to an altered genitourinary microbiome. Our aim was to compare the vaginal and urinary microbiomes b...
Source: Frontiers in cellular and infection microbiology - Category: Microbiology Source Type: research
Abstract STUDY DESIGN: Prospective cohort study OBJECTIVES: We hypothesized that anti-muscarinic agents alter rectal compliance in SCI patients and that altered rectal compliance relates to bowel symptomatology. Our primary aim was to compare rectal compliance before and after the institution of anti-muscarinics (solifenacin and tolterodine) and an adrenoceptor agonist (mirabegron) in these patients. Additionally, we wanted to evaluate if anorectal manometry differed before and after use of anti-muscarinic agents. SETTING: Tertiary neurogastroenterology clinic, London METHODS: Thirty-five patients with suprac...
Source: Anal Sci - Category: Chemistry Authors: Tags: Spinal Cord Source Type: research
AbstractPurpose of ReviewPost-prostatectomy overactive bladder (OAB) is a common and challenging condition to manage. The aim of the present report was to review the recent evidences regarding OAB symptoms that develop in men after prostatectomy and how to manage them.Recent FindingsThe prevalence of OAB after radical prostatectomy may range from 15.2 to 37.8%. Recent studies have highlighted the role of the urethrogenic mechanism (facilitation of the urethrovesical reflex due to stress urinary incontinence (SUI)) in the genesis of post-prostatectomy OAB in a significant proportion of patients. Several other pathophysiolog...
Source: Current Urology Reports - Category: Urology & Nephrology Source Type: research
CONCLUSION: There is actually an insufficient concern about urinary symptoms in normal pressure hydrocephalus. This article highlights the importance of a harmonization of neuro-urological practices in the pre-therapeutic evaluation of patients suffering from normal pressure hydrocephalus. PMID: 27816462 [PubMed - as supplied by publisher]
Source: Progres en Urologie - Category: Urology & Nephrology Tags: Prog Urol Source Type: research
r K Abstract In 2002, the International Continence Society defined the term overactive bladder (OAB) as a symptom syndrome that is accompanied by urgency with or without urge incontinence, frequency and nocturia. A proven urinary tract infection or other obvious pathologies must be excluded.The pathophysiology of OAB has not been clarified in detail and is the subject of ongoing research, so partially overlapping hypotheses exist. The urothelium-based hypothesis suggests functional changes of urothelial receptors as well as functional changes regarding the sensitivity and coupling of the suburothelial myofibroblas...
Source: Aktuelle Urologie - Category: Urology & Nephrology Authors: Tags: Aktuelle Urol Source Type: research
Posterior tibial nerve stimulation (PTNS) is a minimally invasive treatment option for refractory overactive bladder (OAB). But frequent hospital visits and its treatment cost may be prohibitive for patients. As a convenient method, we focused on transcutaneous electrical nerve stimulation (TENS). Although TENS of somatic afferents in foot has reportedly inhibited reflex micturition and increased bladder capacity in anesthetized cats as well as healthy humans, its effect in OAB patients is still unknown.
Source: The Journal of Urology - Category: Urology & Nephrology Authors: Tags: Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II Source Type: research
Brain abnormalities may contribute to the increased prevalence of urinary dysfunction such as overactive bladder and urge incontinence in older individuals. Functional brain imaging suggests that 3 independent neural circuits (frontal, midcingulate, and subcortical) control voiding by suppressing the voiding reflex in the brainstem periaqueductal gray. Damage to the connecting pathways subserving these circuits (white matter hyperintensities) increases with age and is associated both with severity of urge incontinence and changes in brain function. Multicomponent therapies targeting structural and functional neural abnorma...
Source: Clinics in Geriatric Medicine - Category: Geriatrics Authors: Source Type: research
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