European experience with bilateral sacral neuromodulation in patients with chronic lower urinary tract dysfunction
Section snippets
Scientific basis of bilateral stimulation
Schultz-Lampel and Lindstrom [12], [14] performed neurophysiologic studies to compare the efficacy of unilateral and bilateral SNS and to find a scientific basis for the application of bilateral neurostimulation in the clinical setting. In their experiments they reproduced clinical sacral foramen stimulation in isolated S2 SNS in choralose-anaesthetised cats.
A comparison was made between unilateral left and right stimulation and bilateral S2 stimulation. Isolated SNS had excitatory and
Clinical application of bilateral stimulation
Even before the results of research on bilateral sacral nerve neuromodulation were published, some clinicians, especially in Germany, used bilateral neuromodulation in the clinical setting [13], [15]. The basis for clinical application was the bilateral innervation of the bladder [16], [17], [18]. In this clinical trial, however, the authors not only used bilateral stimulation, but the position and the design of the electrode were altered to increase the stimulation efficacy by rendering the
Discussion
Innervation of the bladder is considered bilateral, because each half of the bladder has its own confined innervation [16], [17], [18]. The small bladder afferents (Aδ and C fibers) are conducting the sensations of noxious stimuli, urge, and bladder distention [18], and also are considered bilateral through the pelvic nerve. Therefore, unilateral neuromodulation might be only partially effective, either by not influencing the entire bladder or allowing new formation of pathophysiologic
Summary
Although there is experimental and clinical evidence that bilateral stimulation of the sacral nerves could lead to summation effects, no significant differences in unilateral versus bilateral neuromodulation could be demonstrated in a comparative trial. In some individuals, however, only bilateral stimulation relieved symptoms. Therefore, if a unilateral percutaneous nerve evaluation test fails, a bilateral test should be considered. Further clinical research with long-term follow-up will allow
References (22)
- et al.
Electrical stimulation in the clinical management of the neurogenic bladder
J Urol
(1988) - et al.
Sacral neuromodulation in the treatment of urgency-frequency symptoms: a multicenter study on efficacy and safety
J Urol
(2000) - et al.
Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group
J Urol
(1999) - et al.
Efficacy of sacral nerve stimulation for urinary retention: results 18 months after implantation
J Urol
(2001) - et al.
Functional evaluation of sacral nerve root integrity. Report of a technique
Urology
(1990) - et al.
Sacral nerve neuromodulation in the treatment of patients with refractory motor urge incontinence: long-term results of a prospective longitudinal study
J Urol
(2000) - et al.
Predictors of success with neuromodulation in lower urinary tract dysfunction: results of trial stimulation in 100 patients
J Urol
(1994) - et al.
Novel test lead designs for sacral nerve stimulation: improved passive fixation in an animal model
J Urol
(2000) - et al.
Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction
J Urol
(1998) - et al.
Unilateral versus bilateral sacral neuromodulation in patients with chronic lower urinary tract dysfunction
J Urol
(2002)