European experience with bilateral sacral neuromodulation in patients with chronic lower urinary tract dysfunction

https://doi.org/10.1016/j.ucl.2004.09.011Get rights and content

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

First page preview

First page preview
Click to open first page preview

Cited by (0)

View full text