Is Our Limited Understanding of the Effects of Nerve Stimulation Resulting in Poor Outcomes and the Need for Better "Rescue Programming" in SNM and PTNS, and Lost Opportunities for New Sites of Stimulation? ICI-RS 2024.

IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY
Neurourology and Urodynamics Pub Date : 2025-03-01 Epub Date: 2024-10-10 DOI:10.1002/nau.25600
Marcio Augusto Averbeck, Jerzy B Gajewski, Enrico Finazzi-Agrò, Christopher John Chermansky, Arun Sahai, Michał Późniak, Sanjay Sinha, Giovanni Mosiello, Christopher Harding, Hashim Hashim, Roger Dmochowski, Mohammed Belal, Paul Abrams
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引用次数: 0

Abstract

Aims: Sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) are strongly recommended by international guidelines bodies for complex lower urinary tract dysfunctions. However, treatment failure and the need for rescue programming still represent a significant need for long-term follow-up. This review aimed to describe current strategies and future directions in patients undergoing such therapies.

Materials and methods: This is a consensus report of a Think Tank discussed at the Annual Meeting of the International Consultation on Incontinence - Research Society (ICI-RS), June 6-8, 2024 (Bristol, UK): "Is our limited understanding of the effects of nerve stimulation resulting in poor outcomes and the need for better 'rescue programming' in SNM and PTNS, and lost opportunities for new sites of stimulation?"

Results: Rescue programming is important from two different perspectives: to improve patient outcomes and to enhance device longevity (for implantable devices). Standard SNM parameters have remained unchanged since its inception for the treatment of OAB, nonobstructive urinary retention, and voiding dysfunction. SNM rescue programming includes intermittent stimulation (cycling on), increased frequency and changes in pulse width (PW). The effect of PW setting on SNM outcomes remains unclear. Monopolar configurations stimulate more motor nerve fibers at lower stimulation voltage; hence, this could be an option in patients who failed bipolar stimulation in the long term. Unfortunately, there is little evidence for rescue programming for PTNS. However, the development of implantable devices for intermittent stimulation of the tibial nerve may increase long-term adherence to therapy and increase interest in alternative programming. There has been recent promising neurostimulation targeting the pudendal nerve (PNS), especially in BPS/IC. More recently, preliminary data addressed the benefits of high-frequency bilateral pudendal nerve block for DESD and adaptive PNS on both urgency and stress UI in women.

Conclusion: The exploration of rescue programming and new stimulation sites remains underutilized, and there are opportunities that could potentially expand the therapeutic applications of nerve stimulation. By broadening the range of target sites, clinicians may be able to tailor treatments according to individual patient needs and underlying conditions, thereby improving overall outcomes. However, further studies are still needed to increase the level of evidence, potentially allowing for an individualized treatment both in patients who are candidates for electrostimulation and in those who have already received surgical implants but seek a better outcome.

我们对神经刺激效果的了解有限,是否会导致疗效不佳、在 SNM 和 PTNS 中需要更好的 "抢救方案 "以及失去刺激新部位的机会?ICI-RS 2024。
目的:骶神经调控术(SNM)和经皮胫神经刺激术(PTNS)是国际指南机构强烈推荐的治疗复杂下尿路功能障碍的方法。然而,治疗失败和需要进行抢救治疗仍是长期随访的重要需求。本综述旨在描述接受此类治疗的患者的当前策略和未来方向:本文是 2024 年 6 月 6 日至 8 日(英国布里斯托尔)国际尿失禁咨询-研究协会(ICI-RS)年会上讨论的智囊团共识报告:"结果:从两个不同的角度来看,抢救编程都很重要:改善患者预后和延长设备寿命(对于植入式设备而言)。自用于治疗 OAB、非梗阻性尿潴留和排尿功能障碍以来,标准 SNM 参数一直保持不变。SNM 抢救程序包括间歇性刺激(循环开启)、增加频率和改变脉宽(PW)。脉宽设置对SNM疗效的影响仍不清楚。单极配置能以较低的刺激电压刺激更多的运动神经纤维;因此,这可能是双极刺激长期失败的患者的一种选择。遗憾的是,目前几乎没有证据表明可以对 PTNS 进行抢救性编程。不过,用于间歇性刺激胫神经的植入式设备的开发可能会提高治疗的长期依从性,并增加对替代方案的兴趣。最近,针对阴部神经(PNS)的神经刺激疗法前景看好,尤其是在 BPS/IC 中。最近,初步数据显示,高频双侧阴部神经阻滞治疗 DESD 和适应性 PNS 对女性尿急和压力性尿失禁均有益处:结论:对抢救方案和新刺激部位的探索仍未得到充分利用,而这些机会有可能扩大神经刺激的治疗应用范围。通过扩大目标部位的范围,临床医生可以根据患者的个体需求和潜在病症量身定制治疗方案,从而改善整体疗效。不过,仍需进一步研究以提高证据水平,从而为适合电刺激的患者和已接受手术植入但希望获得更好疗效的患者提供个性化治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurourology and Urodynamics
Neurourology and Urodynamics 医学-泌尿学与肾脏学
CiteScore
4.30
自引率
10.00%
发文量
231
审稿时长
4-8 weeks
期刊介绍: Neurourology and Urodynamics welcomes original scientific contributions from all parts of the world on topics related to urinary tract function, urinary and fecal continence and pelvic floor function.
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