van Ophoven Arndt
Abteilung für Neuro-Urologie, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
Urologie. 2023 Feb;62(2):153-164. doi: 10.1007/s00120-022-02018-9. Epub 2023 Jan 23.
Neuromodulative treatment for the treatment of overactive bladder has been used in clinical practice since its introduction in the early 1980s.
Description and update of the various neuromodulative techniques (tibial nerve stimulation, sacral and pudendal neuromodulation), presentation of their effectiveness and safety, and evaluation of their evidence for clinical practice.
Literature search in PubMed and Embase, inclusion of studies according to the following criteria: evidence level, timeliness, length of follow-up and number of female patients according to the author's preference.
The efficacy and safety of both percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) has been proven by studies with an evidence level of 1. Long-term data of up to 20 years are available for SNM, while long-term data for PTNS are limited. Permanent implants for tibial nerve stimulation are promising new developments. Pudendal neuromodulation (PNM) is suitable for more complex indications but is surgically more challenging.
Both PTNS and SNM are suitable for broad application in clinical practice. PTNS can be offered as an alternative to pharmacotherapy, while SNM provides the most convincing clinical data of all neuromodulative therapies.
自20世纪80年代初引入以来,神经调节疗法已用于治疗膀胱过度活动症的临床实践。
描述并更新各种神经调节技术(胫神经刺激、骶神经和阴部神经调节),介绍其有效性和安全性,并评估其临床实践证据。
在PubMed和Embase上进行文献检索,根据以下标准纳入研究:证据水平、时效性、随访时间以及作者偏好的女性患者数量。
经皮胫神经刺激(PTNS)和骶神经调节(SNM)的有效性和安全性已在证据水平为1的研究中得到证实。SNM有长达20年的长期数据,而PTNS的长期数据有限。用于胫神经刺激的永久性植入物是有前景的新进展。阴部神经调节(PNM)适用于更复杂的适应症,但手术难度更大。
PTNS和SNM均适用于临床实践中的广泛应用。PTNS可作为药物治疗的替代方案,而SNM提供了所有神经调节疗法中最有说服力的临床数据。