Neurostimulation, Neuromodulation and Neurotization in the Therapy of Neurogenic Bladder


Authors: Z. Mackerle 1;  E. Brichtová 1;  P. Zerhau 2;  E. Göpfert 3;  D. Sochůrková 1;  M. Husár 2;  R. Jančálek 1,4
Authors‘ workplace: Neurochirurgická klinika LF MU a FN U sv. Anny v Brně 1;  Urologické oddělení při KDCHOT, FN Brno 2;  Výzkumný ústav veterinárního lékařství, v. v. i., Brno 3;  Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 4
Published in: Cesk Slov Neurol N 2015; 78/111(1): 83-87
Category: Short Communication

Overview

A great number of patients with spinal cord dysfunction of various origin suffer from functional micturition disorders called neurogenic bladder. Most of the therapeutic regimens are aimed at providing adequate urine derivation to prevent upper urinary tract dysfunction. The method of choice is a permanent autocatheterization with pharmacological and surgical facilitation to decrease intravesical pressure. This is the reason for growing tendency to develop methods that would enable spontaneous micturition without the need for further medication. Neurostimulation or neuromodulation of sacral roots, pudendal or tibial nerve are the most prevalent methods. Indirect stimulation of the bladder can be accomplished with electrodes attached to the sacral roots or the pudendal nerve. Neuromodulation is performed by stimulation of the dorsal sacral nerve roots, pudendal nerve or percutaneous stimulation of the tibial nerve. Physiological alternative of the above mentioned stimulation might be neurorrhaphy with the use of persisting functional peripheral nerves or nerve roots as donors. The authors are comparing both methods of stimulation and neurotization based on the literature and animal experiments and outline the neurophysiological basis for potential solutions.

Key words:
neurogenic bladder – neurorrhaphy – neuromodulation – neurostimulation – arteficial voiding reflex arch

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Krhut J et al. Neurourologie. Praha: Galén 2005.

2. Jegorov A, Šlégr Z. Léčba poruch mikce retenčního typu elektrickou stimulací. Cas Lek Cesk 1975; 114(20): 623– 626.

3. Jegorov A, Šlégr Z. Léčba retenčních poruch mikce u paraplegiků. Zpráva o prvních třech implantacích elektrického stimulátoru močového měchýře v Československu. Rozhl Chir 1975; 54(7): 500– 507.

4. Jonas U, Heine JP, Tanagho EA. Studies on the feasibility of urinary bladder evacuation by direct spinal cord stimulation I. Parameters of most effective stimulation. Invest Urol 1975; 13(2): 142– 150.

5. Hald T, Agrawal G, Kantrowitz A. Studies in stimulation of the bladder and its motor nerves. Surgery 1966; 60(4): 848– 856.

6. Brindley GS, Polkey CE, Rushton DN, Cardozo L. Sacral anterior root stimulator for bladder kontrol in paraplegia: the first 50 cases. J Neurol Neurosurg Psychiatry 1986; 49(10): 1004– 1014.

7. Tanagho EA, Schmidt RA, Orvis BR. Neural stimulation for kontrol of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders. J Urol 1989; 142(2): 340– 345.

8. Doležel J, Cejpek P, Miklánek D. Sakrální deaferentace a neurostimulace předních kořenů míšních v léčbě neuropatického močového měchýře u pa­cientů s kompletní transverzální míšní lézí –  první klinické zkušenosti. Rozhl Chir 2002; 81: 203– 209.

9. Van Kerrebroeck PE. Advances in the role of sacral nerve neuromodulation in lower urinary tract symp­toms. Int Urogynecol J 2010; 21 (Suppl 2): S467– S474. doi: 10.1007/ s00192‑ 010‑ 1276‑ 0.

10. Peters KM, Killinger KA, Boguslawski BM, Boura JA. Chronic pudendal neuromodulation: expanding avail­able treatment options for refractory urologic symp­toms. Neurourol Urodyn 2010; 29(7): 1267– 1271. doi: 10.1002/ nau.20823.

11. Burks FN, Bui DT, Peters KM. Neuromodulation and the neurogenic bladder. Urol Clin North Am 2010; 37(4): 559– 565. doi: 10.1016/ j.ucl.2010.06.007.

12. Haninec P, Kaiser R. Operační léčba poranění plexus brachialis. Cesk Slov Neurol N 2011; 74/ 107(6): 619– 630.

13. Brown JM, Barbe MF, Albo ME, Lai HH, Ruggieri MR sr. Anatomical feasibility of performing intercostal and ilioinguinal nerve to pelvic nerve transfer: a pos­sible technique to restore lower urinary tract innervation. J Neurosurg Spine 2012; 17(4): 357– 362. doi: 10.3171/ 2012.7.SPINE12214.

14. Lin H, Hou CL, Zhong G, Xie Q, Wang S. Reconstruction of reflex pathways to the atonic bladder after conus medullaris injury: preliminary clinical results. Microsurgery 2008; 28(6): 429– 435. doi: 10.1002/ micr.20504.

15. Xiao CG, Schlossberg SM, Morgan CW, Kodama R. A possible new reflex pathway for micturition after spinal cord injury. J Urol 1990; 143: 356A.

16. Xiao CG, Godec CJ. A possible new reflex pathway for micturition after spinal cord injury. Paraplegia 1994; 32(5): 300– 307.

17. Xiao CG, de Groat WC, Godec CJ, Dai C, Xiao Q. „Skin‑CNS‑ bladder“ reflex pathway for micturition after spinal cord injury and its underlying mechanisms. J Urol 1999; 162(3): 936– 942.

18. Xiao CG. A somatic‑ autonomic reflex pathway procedure for neurogenic bladder and bowel: results on 92 patients with SCI and 110 children with spina bifida. Proceedings of the International Conference of Urology, July 2– 4. Shanghai, China 2005.

19. Kelley CE, Xiao CG, Weiner H. Creation of a somatic‑ autonomic reflex pathway for treatment of neurogenic bladder in patients with spinal cord injury: preliminary results of the first 2 USA patients. J Urol 2005; 173: 1132A.

20. Wang J, Hou C, Jiang J, Li Q, Li Q, Zhang F. Selection of the sacral nerve posterior roots to establish skin‑CNS‑ bladder reflex pathway: an experimental study in rats. Microsurg 2007; 27(2): 118– 124.

21. Sun F, Chen M, Li W, Xiao C. Effect of the arteficial somato‑ autonomic neuroanastomosis after spinal cord injury and its underlying mechanisms. J Huazhong Univ Sci Techn Med Sci 2010; 30(4): 490– 493. doi: 10.1007/ s11596‑ 010‑ 0455‑ z.

22. Xiao CG, Du MX, Li B, Liu Z, Chen M, Chen ZH et al. An arteficial somatic‑ autonomic reflex pathway procedure for bladder control in children with spina bifida. J Urol 2005; 173: 2112– 2116.

23. Xiao CG. Xiao procedure for neurogenic bladder in spinal cord injury and spinal bifida. Curr Bladder Dysfunct Rep 2012; 7: 83– 87.

24. Gao WS, Dong CJ, Li SQ, Kunwar KJ, Li B. Re‑ innervation of the bladder through end‑to‑ side neurorrhaphy of autonomic nerve and somatic nerve in rats. J Neurotrauma 2012; 29(8): 1704– 1713. doi: 10.1089/ neu.2011.2255.

25. Doležel J. Implementace sakrální deaferentace a neurostimulace sakrálních předních kořenů míšních do systému zdravotní péče o pa­cienty s transverzálními míšními lézemi v České republice. Habilitační práce. Brno: Masarykova univerzita 2009.

26. Peters KM, Carrico DJ, Perez‑ Marrero RA, Khand AU, Wooldridge LS, Davis GL et al. Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT Trial. J Urol 2010; 183(4): 1438– 1443. doi: 10.1016/ j.juro.2009.12.036.

Labels
Paediatric neurology Neurosurgery Neurology
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account