Article

Management of lower urinary tract dysfunction (LUTD) in neurological diseases
remains a priority because it leads to many complications such as incontinence,
renal failure and decreased quality of life. A pharmacological approach remains
the first-line treatment for patients with neurogenic LUTD, but electrical
stimulation is a well-validated and recommended second-line treatment. However,
clinicians must be aware of the indications, advantages and side effects of the
therapy. This report provides an update on the 2 main electrical stimulation
therapies for neurogenic LUTD - inducing direct bladder contraction with the
Brindley procedure and modulating LUT physiology (sacral neuromodulation, tibial
posterior nerve stimulation or pudendal nerve stimulation). We also describe the
indications of these therapies for neurogenic LUTD, following international
guidelines, as illustrated by their efficacy in patients with neurologic
disorders. Electrical stimulation could be proposed for neurogenic LUTD as
second-line treatment after failure of oral pharmacologic approaches.
Nevertheless, further investigations are needed for a better understanding of the
mechanisms of action of these techniques and to confirm their efficacy. Other
electrical investigations, such as deep-brain stimulation and repetitive
transcranial magnetic stimulation, or improved sacral anterior root stimulation,
which could be associated with non-invasive and highly specific deafferentation
of posterior roots, may open new fields in the management of neurogenic LUTD.
CI - Copyright (c) 2015 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS