Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; University Medical Center, Maastricht, The Netherlands.
University Medical Center, Maastricht, The Netherlands.
Neuromodulation. 2024 Feb;27(2):267-272. doi: 10.1016/j.neurom.2023.09.002. Epub 2023 Oct 21.
Overactive bladder (OAB) affects millions of patients worldwide. Its treatment is challenging but improves the patient's quality of life. Besides standard techniques for neuromodulation (sacral and pudendal neuromodulation and posterior tibial nerve stimulation), several new techniques have been investigated to treat symptoms of refractory OAB. The purpose of the present review is to outline the state of the art of new neuromodulation techniques for lower urinary tract dysfunction (LUTD).
In March 2023, a comprehensive MEDLINE, EMBASE, and Scopus search was carried out (keywords: LUTD, new technologies, neuromodulation, LUTS, OAB, painful bladder syndromes, etc). Articles were included according to inclusion (randomized controlled trials, prospective trials, large retrospective studies) and exclusion (case reports, outcomes not clearly expressed in full text, animal studies) criteria. The reference lists of the included studies also were scanned. Both adult and pediatric populations were included, in addition to both neurogenic and nonneurogenic OAB. A narrative review was then performed.
Peroneal neuromodulation, transcutaneous electrical nerve stimulation, magnetic nerve stimulation, and parasacral transcutaneous neuromodulation are the most studied investigative techniques and were shown to yield promising results in treating OAB symptoms. Most studies showed promising results even in the complex scenarios of patients with OAB refractory to standard treatments. Comparing investigational techniques with standard of care and their respective clinical outcomes and safety profiles, and confronting their pros and cons, we reasonably believe that once such treatment modalities are further developed, they could play a role in the OAB treatment algorithm.
Although the described neuromodulation techniques are being intensely studied, the available results are not yet sufficient for any guidelines to recommend their use.
膀胱过度活动症（OAB）影响着全球数以百万计的患者。其治疗具有挑战性，但可以改善患者的生活质量。除了标准的神经调节技术（骶神经和阴部神经调节以及胫后神经刺激）外，还研究了几种新的技术来治疗难治性 OAB 的症状。本综述的目的是概述用于下尿路功能障碍（LUTD）的新型神经调节技术的最新进展。
2023 年 3 月，进行了全面的 MEDLINE、EMBASE 和 Scopus 搜索（关键词：LUTD、新技术、神经调节、LUTS、OAB、膀胱疼痛综合征等）。根据纳入（随机对照试验、前瞻性试验、大型回顾性研究）和排除（病例报告、全文未明确表达的结果、动物研究）标准，纳入了文章。还扫描了纳入研究的参考文献列表。纳入了成人和儿科人群，以及神经源性和非神经源性 OAB。然后进行了叙述性综述。
腓肠神经调节、经皮神经电刺激、磁神经刺激和旁骶部经皮神经调节是研究最多的探索性技术，它们在治疗 OAB 症状方面显示出有希望的结果。大多数研究表明，即使在对标准治疗难治的 OAB 患者的复杂情况下，这些技术也具有良好的效果。将探索性技术与标准治疗以及各自的临床结果和安全性特征进行比较，并比较其优缺点，我们有理由相信，一旦这些治疗方式得到进一步发展，它们可能在 OAB 治疗方案中发挥作用。
尽管描述的神经调节技术正在被深入研究，但目前的结果还不足以推荐其使用。
