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The e-mémoires of the Académie Nationale de Chirurgie

Neuromodulation and neurostimulation for management of voiding disorders

Emmanuel CHARTIER-KASTLER

Seance of wednesday 22 june 2022 (Neuropelvinéologie)

DOI number : 10.26299/qaa3-dr51/emem.2022.23.03

Abstract

Brindley’s stimulation and sacral neuromodulation (SNM) are two very different techniques :
Aimed to use electrical energy to stimulate a nerve in order to treat voiding disorders
Born in the second half of the XXth century in parallell.

Brindley’s stimulation is aimed to permit full micturition in spinal cord injury patients. Indications and technique are very specific.
Exacerbation of bladder sensations (urgency), pollakiuria, urgency urinary incontinence, all these symptoms named OAB (overactive bladder), dysuria, chronic urinary retention are clinical indications for SNM. All patients facing failure of first line therapy or non tolerable side effects may be candidates for this therapy. Chronic and permanent stimulation leads to modulation of the normal reflexes through spinal and deep brain pathways. Clinical respons is valid if > 50 % of improvement of symptoms is reported by the patient.

Key words : incontinence, neurostimulation, sacral modulation