Neuromodulation of the lower urinary tract by peripheral electrical stimulation of somatic afferents

Purpose: Neuromodulation by electrical stimulation of peripheral nerves for treatment of lower urinary tract dysfunctions is presented for discussion concerning its importance for patients with neurogenic and non-neurogenic bladder dysfunctions. Materials and methods: This paper reviews the international literature on the subject and discusses the importance of peripheral neuromodulation for treatment of lower urinary tract dysfunctions. Results: Animal and clinical trials showed beneficial effects on bladder function by stimulation of genital, anal and tibial afferents in patients with neurogenic and non-neurogenic bladder dysfunctions. However, the exact mode of action of this therapeutical option remains unclear. Mainly clinical symptoms were used to determine success of treatment. Additionally, some urodynamically controlled studies showed benefit for patients with urge or reflex incontinence. Generally no side effects occur. Neuromodulation offers a potential curative effect, even if little is known about long-term effectivness and no controlled clinical trials are available. At present there is still a lack of standardisation in stimulation parameters, patient selection and success criteria. Conclusions: Neuromodulation of bladder dysfunction by stimulation of somatic afferents appears to be an effective treatment modality for a variety of bladder dysfunctions and offers new perspectives between ineffective drug treatment and surgery.