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Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives

Authors Janssen DAW, Martens FMJ, de Wall LL, van Breda HMK, Heesakkers JPFA

Received 24 January 2017

Accepted for publication 4 April 2017

Published 1 June 2017 Volume 2017:10 Pages 109—122


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Dick AW Janssen,1 Frank MJ Martens,1 Liesbeth L de Wall,1 Hendrikje MK van Breda,2 John PFA Heesakkers1

1Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, 2Department of Urology, University Medical Center Utrecht, Utrecht, the Netherlands

Objectives: This review describes the evidence from established and experimental therapies that use electrical nerve stimulation to treat lower urinary tract dysfunction.
Methods: Clinical studies on established treatments such as percutaneous posterior tibial nerve stimulation (P-PTNS), transcutaneous electrical nerve stimulation (TENS), sacral nerve stimulation (SNS) and sacral anterior root stimulation (SARS) are evaluated. In addition, clinical evidence from experimental therapies such as dorsal genital nerve (DGN) stimulation, pudendal nerve stimulation, magnetic nerve stimulation and ankle implants for tibial nerve stimulation are evaluated.
Results: SNS and P-PTNS have been investigated with high-quality studies that have shown proven efficacy for the treatment for overactive bladder (OAB). SARS has proven evidence-based efficacy in spinal cord patients and increases the quality of life. TENS seems inferior to other OAB treatments such as SNS and P-PTNS but is noninvasive and applicable for ambulant therapy. Results from studies on experimental therapies such as pudendal nerve stimulation seem promising but need larger study cohorts to prove efficacy.
Conclusion: Neurostimulation therapies have proven efficacy for bladder dysfunction in patients who are refractory to other therapies.
Significance: Refinement of neurostimulation therapies is possible. The aim should be to make the treatments less invasive, more durable and more effective for the treatment of lower urinary tract dysfunction.

Keywords: neuromodulation, overactive bladder syndrome, sacral nerve stimulation, sacral anterior root stimulation, PTNS, implant

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