The application of electrical stimulation for the management of neurogenic disorders of urination: the historical prospects and the available possibilities

Abstract

The present article outlines the major landmarks in the development of the methods for electrical stimulation of the lower urinary tract for the management of various neurogenic disorders of urination. The evolution of these methods, from highly traumatic to minimally invasive ones, is considered. The results of the clinical studies demonstrate the high effectiveness of tibial and pudendal neuromodulation in the cases of detrusor hyperactivity resulting from the ischemic lesion of the brain. The neuromodulation takes advantage of the neuronal response of the higher brain centres controlling urination to the electrical irritation of the nerve and muscle fibers of the urinary bladder, the urethra, and the pelvic bottom that constitute the peripheral links of micturition reflexes. The effect of tibial nerve stimulation is associated with the influence on the reflexes closed at the level of the Barrington’s nucleus and activating the pressor influences on the detrusor whereas pudendal stimulation activates selected portions of the cortex of the large hemispheres.

Keywords

electrostatic stimulation of the lower urinary tract / tibial neuromodulation / pudendal neuromodulation / neurogenic detrusor hyperactivity / micturition reflexes / Barrington's nucleus

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