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DOI: 10.1055/s-2001-17268
Neuromodulation des unteren Harntraktes durch periphere Elektrostimulation somatischer Afferenzen
Neuromodulation of the Lower Urinary Tract by Peripheral Electrical Stimulation of Somatic AfferentsPublikationsverlauf
Publikationsdatum:
18. September 2001 (online)
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Zusammenfassung
Fragestellung: Die Neuromodulation der Blasenfunktion durch die periphere Stimulation somatischer Afferenzen soll dargestellt und der Stellenwert dieser Therapie bei Patienten mit funktionellen und neurogenen Blasenfunktionsstörungen diskutiert werden.
Material und Methodik: In dieser Übersichtsarbeit erfolgen die Darstellung und Diskussion der Literatur über die Elektrostimulation somatischer Afferenzen zur peripheren Neuromodulation der Blasenfunktion und deren Bedeutung bei funktionellen und neurogenen Störungen des unteren Harntraktes.
Ergebnisse: Sowohl Tierversuche als auch klinische Studien haben gezeigt, dass durch eine Stimulation genitaler, analer und tibialer Afferenzen eine Modulation der Blasenfunktion möglich ist, und dass Patienten mit funktionellen und neurogenen Blasenfunktionsstörungen von der Behandlung profitieren.
Der genaue Wirkungsmechanismus der Neuromodulation bleibt trotz einiger tierexperimentell untermauerter Hypothesen unklar. In der Mehrzahl der Studien wird der Behandlungserfolg an der Verbesserung der klinischen Symptomatik gemessen, aber auch eine Reihe urodynamisch kontrollierter Untersuchungen konnte einen Benefit für Patienten mit Urge- bzw. Reflexinkontinenz nachweisen. Im Gegensatz zu anderen konservativen und auch chirurgischen Therapieoptionen hat die Behandlung einen potenziell heilenden Ansatz. Bisher wurden keinerlei Nebenwirkungen beobachtet. Wenig bekannt ist über die Langzeitwirkungen, ebensowenig sind kontrollierte Studien verfügbar. Es fehlt weiterhin eine Standardisierung der Stimulationsparameter und der Auswahl- und Erfolgskriterien.
Schlussfolgerung: Die Neuromodulation der Blasenfunktion durch periphere Elektrostimulation somatischer Afferenzen scheint eine effektive Behandlung einer Vielzahl von Funktionsstörungen des unteren Harntraktes zu sein und kann eine neue therapeutische Perspektive zwischen einer ausgereizten medikamentösen Behandlung und invasiveren Strategien eröffnen.
Abstract
Purpose: Neuromodulation by electrical stimulation of peripheral nerves for treatment of lower urinary tract dysfunctions is presented for discussion concerning its importance for patients with neurogenic and non-neurogenic bladder dysfunctions.
Materials and methods: This paper reviews the international literature on the subject and discusses the importance of peripheral neuromodulation for treatment of lower urinary tract dysfunctions.
Results: Animal and clinical trials showed beneficial effects on bladder function by stimulation of genital, anal and tibial afferents in patients with neurogenic and non-neurogenic bladder dysfunctions. However, the exact mode of action of this therapeutical option remains unclear. Mainly clinical symptoms were used to determine success of treatment. Additionally, some urodynamically controlled studies showed benefit for patients with urge or reflex incontinence. Generally no side effects occur. Neuromodulation offers a potential curative effect, even if little is known about long-term effectivness and no controlled clinical trials are available. At present there is still a lack of standardisation in stimulation parameters, patient selection and success criteria.
Conclusions: Neuromodulation of bladder dysfunction by stimulation of somatic afferents appears to be an effective treatment modality for a variety of bladder dysfunctions and offers new perspectives between ineffective drug treatment and surgery.
Key words:
Urinary tract - Electrical stimulation - Afferent pathways
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