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Electrical stimulation in the treatment of bladder dysfunction: technology update

Authors Coolen RL, Groen J, Blok BFM

Received 16 May 2019

Accepted for publication 24 July 2019

Published 11 September 2019 Volume 2019:12 Pages 337—345


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

RL Coolen, J Groen, BFM Blok

Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands

Correspondence: BFM Blok
Department of Urology, Erasmus Medical Center, Room SK-1270, Doctor Molewaterplein 40, Rotterdam 3015 GD, The Netherlands
Tel +31 10 703 2414
Fax +31 10 703 5632

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.

Keywords: lower urinary tract symptoms, neurogenic bladder, electrical stimulation, neuromodulation, sacral neuromodulation, tibial nerve stimulation

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