Krhut Jan, Kobberø Hanne, Kanaan Reine, Fode Mikkel, Poulsen Mads, Zvara Peter
Department of Urology, University Hospital, Ostrava, Czech Republic.
Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.
Nat Rev Urol. 2024 Dec 9. doi: 10.1038/s41585-024-00967-8.
Neuromodulation has been used in the treatment of various pelvic organ dysfunctions for almost 40 years and several placebo-controlled studies have confirmed its clinical effect. Many neuromodulation methods using different devices and stimulation parameters, targeting different neural structures have been introduced, but only a limited number have been adopted into routine clinical use. A substantial volume of basic research and clinical studies addressing specific effects of neuromodulation in the treatment of overactive bladder (OAB) have been published to date; however, their mechanistic implications have not been comprehensively summarized. Thus, our understanding of the mechanism of action of neuromodulation in OAB treatment is mainly based on postulated theories. Results from animal experiments suggest that different neuromodulation methods used to treat OAB share the same basic principles. The most likely explanation for the effect of neuromodulation in OAB therapy is the suppression of bladder afferent signalling, promotion of spinal guarding reflexes and modulation of non-specific supraspinal regulatory circuits.
神经调节用于治疗各种盆腔器官功能障碍已有近40年，多项安慰剂对照研究证实了其临床效果。已经引入了许多使用不同设备和刺激参数、针对不同神经结构的神经调节方法，但只有少数被纳入常规临床应用。迄今为止，已经发表了大量关于神经调节治疗膀胱过度活动症（OAB）的特定效果的基础研究和临床研究；然而，它们的机制意义尚未得到全面总结。因此，我们对神经调节在OAB治疗中的作用机制的理解主要基于假设理论。动物实验结果表明，用于治疗OAB的不同神经调节方法具有相同的基本原理。神经调节在OAB治疗中产生效果的最可能解释是抑制膀胱传入信号、促进脊髓保护反射以及调节非特异性脊髓上调节回路。
