Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
J Urol. 2011 Sep;186(3):798-804. doi: 10.1016/j.juro.2011.02.2696. Epub 2011 Jul 23.
The anatomy of the pudendal nerve and its nerve branches, especially the dorsal nerve of the penis and clitoris (dorsal genital nerves), and the clinical application of electrical stimulation of these nerves in patients with overactive bladder syndrome and detrusor overactivity are reviewed.
A literature search was performed using the PubMed® database and reference lists of relevant studies to obtain articles concerning the anatomy as well as the electrical stimulation of the pudendal nerve and its nerve branches in patients with overactive bladder syndrome.
According to the anatomy, electrical stimulation of the pudendal nerve and the dorsal genital nerves to suppress involuntary detrusor contractions is possible at several sites along their course from the sacral nerves to the penis or clitoris. The nerves are accessible by minimally invasive percutaneous methods. Stimulation of the pudendal nerve and dorsal genital nerves effectively increases bladder capacity, and inhibits involuntary detrusor contractions and overactive bladder symptoms.
More clinically applied studies are recommended for stimulation of the dorsal genital nerves to assess its value and feasibility because most studies have been performed in an acute and experimental setting. The preferred type of electrode is not known, but if wire electrodes can be implanted and fixated well by a minimally invasive procedure, cuff electrodes are not necessary. Before deciding on continuous or conditional stimulation, chronic clinical studies are recommended because acute studies remain inconclusive. The feasibility of conditional stimulation depends on the availability of a reliable and clinically applicable detrusor activity sensor.
综述阴部神经及其分支（即阴茎和阴蒂背神经[阴部生殖器神经]）的解剖结构，以及这些神经在治疗膀胱过度活动症和逼尿肌过度活动患者中的电刺激的临床应用。
通过 PubMed®数据库和相关研究的参考文献进行文献检索，获取有关阴部神经及其分支在治疗膀胱过度活动症患者中的解剖和电刺激的文章。
根据解剖学，从骶神经到阴茎或阴蒂，沿着阴部神经和阴部生殖器神经的走行，在几个部位对其进行电刺激可以抑制不自主逼尿肌收缩。这些神经可以通过微创经皮方法触及。刺激阴部神经和阴部生殖器神经可有效增加膀胱容量，并抑制不自主逼尿肌收缩和膀胱过度活动症状。
由于大多数研究都是在急性和实验环境中进行的，因此建议开展更多的临床应用研究来评估刺激阴部生殖器神经的价值和可行性。尚不清楚哪种类型的电极最佳，但如果可以通过微创程序将线电极植入并固定良好，则无需使用环形电极。在决定进行连续或条件刺激之前，建议进行慢性临床研究，因为急性研究仍存在争议。条件刺激的可行性取决于是否有可靠且适用于临床的逼尿肌活动传感器。
