Kessler T M, de Wachter S
Neuro-Urologie, Zentrum für Paraplegie, Universitätsklinik Balgrist, Universität Zürich, Forchstraße 340, 8008, Zürich, Schweiz.
Department of Urology, University Hospital Antwerp, University of Antwerp, Antwerpen, Belgien.
Urologe A. 2017 Dec;56(12):1591-1596. doi: 10.1007/s00120-017-0526-x.
Neuromodulative procedures such as transcutaneous electrical nerve stimulation (TENS), transcutaneous/percutaneous tibial nerve stimulation (TTNS/PTNS), and sacral neuromodulation (SNM) are promising second-line treatments for refractory lower urinary tract dysfunction. Using these therapies, both storage and voiding disorders but also bowel dysfunction might be successfully treated. Although the mechanism of action of neuromodulation is not well understood, it seems to involve modulation of spinal cord reflexes and brain networks by peripheral afferents (genital/rectal, tibial and sacral afferents in the case of TENS, TTNS/PTNS, and SNM, respectively). Neuromodulative procedures might also be highly effective in the most desperate situations and further relevant developments are expected so that these innovative techniques will most likely become even more important in urology.
神经调节疗法，如经皮电神经刺激（TENS）、经皮/经胫神经刺激（TTNS/PTNS）和骶神经调节（SNM），是治疗难治性下尿路功能障碍很有前景的二线治疗方法。使用这些疗法，不仅可以成功治疗储尿和排尿障碍，还可以治疗肠道功能障碍。尽管神经调节的作用机制尚未完全明确，但似乎涉及外周传入神经（分别在TENS、TTNS/PTNS和SNM中为生殖/直肠、胫神经和骶神经传入神经）对脊髓反射和脑网络的调节。神经调节疗法在最危急的情况下可能也非常有效，预计还会有进一步的相关进展，因此这些创新技术很可能在泌尿外科中变得更加重要。
