Neuromodulation in Urology: Current Trends and Future Applications

Urological applications of neuromodulation and neurostimulation are among the most evolving fields for these technologies. First approved for management of refractory urge incontinence, different modalities of neuromodulation and stimulation have been tested, applied and verified for a vast spectrum of voiding and pelvic floor dysfunction disorders. The modalities of delivering this treatment have also evolved in the last three decades, with a focus on sacral neuromodulation. The experimental and established “off-label” applications of neuromodulation have also encompassed chronic pelvic pain disorders, including chronic prostatitis and bladder pain syndrome, among others. In this chapter, we discuss all the hypothesized theories suggested on how this technology provides therapeutic potential for a number of chronic and debilitating urological conditions, the modes of delivery be it anterior, sacral, and posterior tibial to name a few, and the evolving and future applications

Clinical Outcomes involving the Use of Extracorporeal Magnetic Innervation in the Treatment of Urinary Incontinence

ABSTRACT CLINICAL OUTCOMES INVOLVING THE USE OF EXTRACORPOREAL MAGNETIC INNERVATION IN THE TREATMENT OF URINARY INCONTINENCE by KATHY E. DAVIS Urinary incontinence affects approximately 25 million Americans, significantly diminishing their function and quality of life. It is estimated that 50% of all women will experience some form of urinary incontinence in their lifetime. Although women are disproportionately affected by urinary incontinence, 69% of men who have undergone prostatectomy also report post-surgical incontinence. Extracorporeal Magnetic Innervation (ExMI) is a novel conservative approach to the treatment of urinary incontinence. As a patient sits fully clothed on a chair, an electromagnet delivers a timed magnetic field that penetrates the pelvic floor, inducing a nerve impulse that prompts contractions of the muscles of the pelvic floor. When the magnet is switched off, the muscles relax. This forced, passive exercise of the pelvic floor muscles serves to build endurance and strengthen the muscles supporting the bladder during times of physical stress such as coughing, laughing or running. This study is a descriptive, retrospective analysis of data collected from a specialty continence center within a major Atlanta metropolitan outpatient facility. The records for all patients who received ExMI from 2000 to 2012 were reviewed. Of the 43 patients who had received ExMI, 35 met study inclusion criteria. Eight patients were eliminated from the study. Four of these patients experienced ExMI benefits for conditions unrelated to urinary incontinence and are discussed. Data were analyzed using descriptive and inferential statistics. . The majority of the patients were women (n=26, 74%); most patients had stress urinary incontinence (n=16, 46%) or mixed urinary incontinence (n=12, 34%). The patient outcome was determined by comparing the pad usage before treatment and at the end of treatment (16 weeks). The average number of pads used daily was significantly reduced to 1.6 3 + 0.94 (p\u3c.0001). Treatment with ExMI for urinary incontinence was briefly popular in the United States shortly after it was introduced. Although ExMI is used extensively across Europe and Asia, very few studies on the efficacy of ExMI appear in the literature. These results will add to this body of knowledge

Improving Sacral Neuromodulation for Lower Urinary Tract and Bowel Dysfunction:A Translational and Multidisciplinary Approach

Lower urinary tract and bowel dysfunction are associated with a decreased control of micturition and/or defecation. Sacral neuromodulation (SNM), using electrical stimulation of a nerve root in the lower back, is a treatment for these disorders and provides patients a better quality of life. In this thesis, two animal models, one for faecal incontinence and one for lower urinary tract dysfunction, were further optimized. These optimized models now allow future studies to investigate and improve interventions for lower urinary tract and bowel dysfunction, such as SNM. In addition, this thesis provides a systematic overview of the recent developments in the use and efficacy of SNM stimulation parameters in clinical and animal studies and revealed that the therapeutic effect of SNM can be improved by adjusting relevant stimulation parameters. Lastly, this thesis showed that a new form of SNM, called Burst-SNM, can modulate bladder and urethral responses in a distinctive way as compared to standard SNM stimulation parameters. These findings provide a new perspective to further optimize clinical outcome

Lower Urinary Tract Dysfunction

Lower urinary tract dysfunction (LUTD) is an umbrella diagnosis that covers the abnormalities of anatomy and function in the bladder, urethra, and, in men, the prostate. People with LUTD face a number of social, mental, and physical health effects due to the symptoms. Despite the increasing evidence in the assessment and management of lower urinary tract symptoms, it remains a challenge to bridge the gap between research evidence and clinical practice. In this book, each and every one of the authors presents a remarkable work for how to apply the evidence to clinical practice from different aspects. I hope this book is a key for every reader to open the door to LUTD

Preventing Erectile Dysfunction after Radical Prostatectomy: Nerve-Sparing Techniques, Penile Rehabilitation, and Novel Regenerative Therapies

Erectile dysfunction is a known and much-dreaded functional consequence of radical prostatectomy. Dr. Patrick Walsh pioneered the nerve-sparing radical retropubic prostatectomy in the early 1980s, which has mitigated the morbidity of this surgery. Post-operative potency rates range widely from 20 to 80%, however, and depend on myriad factors including age, preoperative potency, and degree of nerve-sparing during surgery. Over the past four decades several developments have continued to offer hope to patients and clinicians alike, including refined understanding of cavernosal nerve neuroanatomy, beneficial modifications in surgical technique, as well as the advent of robotic surgery. Furthermore, multiple pre- and post-operative penile rehabilitation techniques using mechanotherapy and pharmaceuticals have also improved functional recovery. This paper examines erectile dysfunction as a consequence of radical prostatectomy, including the physiology of erections, the pathophysiology of post-operative erectile dysfunction, novel surgical techniques to enhance neurovascular bundle preservation, and penile rehabilitation strategies involving hyperbaric oxygen, neuroprotective pharmaceuticals, dehydrated human amnion-chorion membrane allografts, and mesenchymal stem cell therapy