Clinical efficacy of intravesical electrical stimulation on detrusor underactivity: 8 Years of experience from a single center

Han Deng, Limin Liao, Juan Wu, Guoqing Chen, Xing Li, Zhaoxia Wang, Li Wan, Han Deng, Limin Liao, Juan Wu, Guoqing Chen, Xing Li, Zhaoxia Wang, Li Wan

Abstract

The aim of this study was to retrospectively evaluate the effectiveness of intravesical electrical stimulation (IVES) on detrusor underactivity (DU).From 2009 to 2016, a total of 105 patients with symptoms of DU who were treated with IVES were included in this retrospective study. The medical records, physical examination findings, urine culture results, and video-urodynamic studies were reviewed. Changes in post-void residual urine (PVR) and voiding efficiency (VE) were included for evaluation of efficacy. Patients achieving a >50% reduction in the PVR were regarded as responders. A >80% reduction in the PVR was considered obvious improvement. A questionnaire was administered to patients with bladder sensation.Of the 105 patients, the information of residual urine volume and voiding volume was obtained in 89 patients, and detailed pre- and post-IVES bladder sensation information was available on 96 patients. Of the 89 patients, 47.2% (42/89) were responders and achieved a >50% reduction in the PVR. Obvious improvement in the PVR, defined as a >80% reduction, occurred in 27% (24/89) of the patients. VE developed in 76.4% (68/89) of the patients, and 30.3% (27/89) of the patients increased >50%. Significant improvements in the PVR and VE were observed during IVES treatment (P < .05). Based on the questionnaire, bladder sensation developed and was sustained in 44.8% (43/96) of the patients.IVES provides a promising method for improving the PVR and VE in a majority of patients with DU. Thus, IVES is worth to further study and carry out.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The insert mode of the active electrode. Patients were treated by inserting a sterile active electrocatheter via the urethra into the bladder.
Figure 2
Figure 2
A, Mean PVR and (B) mean VE of 89 patients between pre- and post-IVES. Values are expressed as the mean ± SD. A, ∗P < .0001, (B) ∗P < .0001. IVES = intravesical electrical stimulation, PVR = post-void residual urine, VE = voiding efficiency.

References

    1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Am J Obstet Gynecol 2002;187:116–26.
    1. Hoebeke P, Van Laecke E, Van Camp C, et al. One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int 2001;87:575–80.
    1. Webb RJ, Lawson AL, Neal DE. Clean intermittent self-catheterisation in 172 adults. Br J Urol 1990;65:20–3.
    1. Miyazato M, Yoshimura N, Chancellor MB. The other bladder syndrome: underactive bladder. Rev Urol 2013;15:11–22.
    1. Moreno-Palacios J, Maldonado-Alcaraz E, Montoya-Martínez G, et al. Outcomes and complications of sphincterotomy with bladder neck incision in neurologically healthy male patients with voiding dysfunction. Arch Esp Urol 2012;65:244–50.
    1. Kaplan WE, Richards I. Intravesical transurethral electrotherapy for neurogenic bladder. J Urol 1986;136:243–6.
    1. Wyndaele JJ, Madersbacher H, Kovindha A. Conservative treatment of the neuropathic bladder in spinal cord injured patients. Spinal Cord 2001;39:294–300.
    1. Madersbacher H. Intravesical electrical stimulation for the rehabilitation of the neuropathic bladder. Paraplegia 1990;28:349–52.
    1. Wyndaele JJ. Conservative treatment of patients with neurogenic bladder. Euro Urol Suppl 2008;7:557–65.
    1. Katona F, Berenyi M. Intravesical transurethral electrotherapy of bladder paralysis. Orv Hetil 1975;116:854–6.
    1. Hagerty JA, Richards I, Kaplan WE. Intravesical electrotherapy for neurogenic bladder dysfunction: a 22-year experience. J Urol 2007;178:1680–3.
    1. Gladh G, Mattsson S, Lindström S. Intravesical electrical stimulation in the treatment of micturition dysfunction in children. Neurourol Urodyn 2003;22:233–42.
    1. Madersbacher H, Pauer W, Reiner E, et al. Rehabilitation of micturition in patients with incomplete spinal cord lesions by transurethral electrostimulation of the bladder. Eur Urol 1982;8:111–6.
    1. Kaplan WE. Intravesical electrical stimulation of the bladder: pro. Urology 2000;56:2–4.
    1. Maynard FM, Bracken MB, Creasey G, et al. International standards for neurological and functional classification of spinal cord injury. Spinal Cord 1997;35:266–74.
    1. Van Balken MR, Vergunst H, Bemelmans BLH. The use of electrical devices for the treatment of bladder dysfunction: a review of methods. J Urol 2004;172:846–51.
    1. Jiang CH. Modulation of the micturition reflex pathway by intravesical electrical stimulation: an experimental study in the rat. Neurourol Urodyn 1998;17:543–53.
    1. Jiang CH, Lindstrom S. Intravesical electrical stimulation induces a prolonged decrease in micturition threshold volume in the rat. J Urol 1996;155:1477–81.
    1. Jiang CH, Lindstrom S. Prolonged enhancement of the micturition reflex in the cat by repetitive stimulation of bladder afferents. J Physiol 1999;517:599–605.
    1. Choi EK, Hong CH, Kim MJ, et al. Effects of intravesical electrical stimulation therapy on urodynamic patterns for children with spina bifida. A 10-year experience. J Pediatr Urol 2013;9:798–803.
    1. Ebner A, Jiang C, Lindström S. Intravesical electrical stimulation–an experimental analysis of the mechanism of action. J Urol 1992;148:920–4.
    1. Nicholas JL, Eckstein HB. Endovesical electrotherapy in treatment of urinary incontinence in spina-bifida patients. Lancet 1975;2:1276–7.
    1. Lombardi G, Celso M, Mencarini M, et al. Clinical efficacy of intravesical electrostimulation on incomplete spinal cord patients suffering from chronic neurogenic non-obstructive retention. A 15-year single centre retrospective study. Spinal Cord 2013;51:232–7.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir