Neuromodulation in neurogenic bladder

Melissa T Sanford, Anne M Suskind, Melissa T Sanford, Anne M Suskind

Abstract

While neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and urinary retention, its applicability to the neurogenic bladder population has only recently been examined more in depth. In this article we will discuss the outcomes, contraindications, and special considerations of sacral and percutaneous tibial nerve stimulation (PTNS) in patients with neurogenic lower urinary tract dysfunction.

Keywords: Neurogenic bladder; implantable neurostimulators.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
During the normal micturition reflex bladder afferent fibers signal fullness to bladder efferent fibers through spinal interneurons which are then influenced upon by supraspinal feedback (either negative for inhibition of voiding or positive for initiation of voiding). In overactive bladder there is thought to be loss of supraspinal feedback regulating the normal micturition reflex. Neuromodulation is postulated to work in the setting of bladder overactivity by activating peripheral somatic afferent nerves (i.e., the pudendal or posterior tibial nerve) which in turn inhibit signals from the bladder afferents at the level of the spinal cord and thus disrupt an aberrant micturition reflex. Urinary retention is promoted by the guarding and bladder afferent reflexes. Neuromodulation is postulated to work in the setting of urinary retention by restoring normal afferent signaling from the bladder in the midbrain and reducing cortical activity which stimulates the guarding reflex (1). SNM, sacral neuromodulation.

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