Articles: urinary-bladder-therapy.
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Cochrane Db Syst Rev · Nov 2013
ReviewCatheter policies for management of long term voiding problems in adults with neurogenic bladder disorders.
Management of the neurogenic bladder has the primary objectives of maintaining continence, ensuring low bladder pressure (to avoid renal damage) and avoiding or minimising infection. Options include intermittent urethral catheterisation, indwelling urethral or suprapubic catheterisation, timed voiding, use of external catheter (for men), drug treatment, augmentation cystoplasty and urinary diversion. ⋯ Despite a comprehensive search no evidence from randomised or quasi-randomised controlled trials was found. It was not possible to draw any conclusions regarding the use of different types of catheter in managing the neurogenic bladder.
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Neurogenic bladder associated with spinal cord injury (SCI) often results in serious disruption of lower urinary tract function. Compared to conventional therapies, sacral neuromodulation (SNM) may offer an alternative, non-destructive treatment for SCI patients with bladder dysfunction. Understanding bladder reflex changes following SCI and the effects of SNM may yield new insights for innovative use of this promising technique. Using a SCI rat model developed in this study, we investigated: 1) the bladder responses with different grades of bladder filling in intact and SCI rats; and 2) the effects of acute SNM on bladder reflex responses in SCI rats. ⋯ The spinal rat model developed in this study was suitable to investigate the effect of sacral neural stimulation on micturition reflex. The results of present study demonstrated that the micturition reflex can be modulated by sacral neural stimulation.
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The Journal of urology · Aug 2013
Comparative StudyPosterior tibial nerve stimulation vs parasacral transcutaneous neuromodulation for overactive bladder in children.
Parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation have emerged as effective methods to treat overactive bladder in children. However, to our knowledge no study has compared the 2 methods. We evaluated the results of parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation in children with overactive bladder. ⋯ We found that parasacral transcutaneous electrical nerve stimulation is more effective in resolving overactive bladder symptoms, which matches parental perception. However, there were no statistically significant differences in the evaluation by dysfunctional voiding symptom score, or in complete resolution of urgency or diurnal incontinence.
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Electrical stimulation of the posterior tibial nerve (PTN) is an established therapy for the treatment of refractory overactive bladder syndrome (OAB). The Urgent-SQ™ is an implant that is surgically placed near the PTN and activated by an external pulse generator, allowing for "on demand" PTN stimulation, without the need for needle insertion. The current study presents results of a 9-year, open-label, follow-up of eight patients to address the long term safety and efficacy of the implant. ⋯ After 9 years of clinical experience, we demonstrated that implant driven PTNS with the Urgent-SQ™ is a safe therapy for OAB. The implant has a long lifespan and is well tolerated by patients.
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The Journal of urology · Jun 2013
Randomized Controlled TrialPercutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study.
We report the long-term efficacy and safety of percutaneous tibial nerve stimulation with the Urgent® PC Neuromodulation System for overactive bladder after 3 years of therapy. ⋯ Most STEP participants with an initial positive response to 12 weekly percutaneous tibial nerve stimulation treatments safely sustained overactive bladder symptom improvement to 3 years with an average of 1 treatment per month.