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Neural engineering
Published in Alex Mihailidis, Roger Smith, Rehabilitation Engineering, 2023
Another alternative involves the electrical activation of the posterior tibial nerve (derived from L5 to S3 spinal roots). This treatment approach was first investigated by McGuire et al. (1983), where significant improvements in urinary function were demonstrated across a wide range of patients that included idiopathic OAB to chronic SCI. It was commercialized as the Stoller afferent nerve stimulator (SANS) and is now clinically available as Urgent PC (Laborie Inc, Canada). Also referred to as PTNS therapy, it is clinically implemented as weekly stimulation sessions during which the clinician inserts a percutaneous needle electrode in close proximity to the posterior tibial nerve and uses a hand-held pulse generator to deliver 30 minutes of continuous electrical stimulation (pulse width = 200 µs, frequency = 20 Hz, and amplitude = maximum 9 mA). Each session is repeated weekly over a period of three months, at which time patients achieve at least a 50% decrease in urgency and/or urge-incontinence episodes (Vandoninck et al. 2003; van Balken 2007). The therapeutic effects of PTNS therapy have also been validated in randomized, double-blind studies that compare electrical neuromodulation with pharmacological treatment and even sham nerve stimulation (Kenneth M. Peters et al. 2009; Kenneth M. Peters et al. 2010; Finazzi-Agrò et al. 2010). However, a recent meta-analysis shows that the overall success rate of PTNS therapy is limited to approximately 60% of patients (Burton et al. 2012).
Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects
Published in Expert Review of Medical Devices, 2022
Sam Tilborghs, Stefan De Wachter
Advancements in research should thrive for restoration of lower urinary tract function and >90% ITT response as definitive endpoints. This could lead to an expansion of different conditions eligible for SNM and potentially even combined treatments. Efficacy rates vary between neuromodulation techniques, with the highest efficacy rates seen for SNM [207]. Currently it is unknown if a combination of (neuromodulation) treatments with different stimulation targets could cause a potential add-on effect. Other options are, for example, percutaneous tibial nerve stimulation (PTNS), however, overall improvements seem to remain modest [208]. While sacral neuromodulation excites a select few pudendal nerve fibers, direct neurostimulation of the pudendal nerve itself may also suppress voiding reflex. Marinkovic et al. stated that pudendal neuromodulation could serve as a welcome addition for failed SNM patients, demonstrating the need for pudendal neuromodulation to be prospectively studied [6].