Search Results (25)

Background: Refractory overactive bladder (OAB) poses a significant clinical burden, often severely impacting quality of life (QoL). While intradetrusor onabotulinumtoxinA (BoNT-A) and sacral neuromodulation (SNM) are established therapeutic options, a direct comparison of their efficacy and safety profiles is essential to guide clinical decision-making. This study compares BoNT-A against placebo and SNM for the management of refractory OAB in women. Methods: Following PRISMA guidelines, PubMed, Scopus, CENTRAL, and Google Scholar were searched until February 2025 for randomized controlled trials (RCTs) and cohort studies on treatment alternatives for refractory OAB. Treatment outcomes at 3- (BoNT-A vs. placebo) and 6-month (BoNT-A vs. SNM) follow-up were analyzed. Odds ratios (ORs) and mean differences (MDs) were calculated for dichotomous and continuous variables, respectively, with heterogeneity assessed via I² test. Study quality was evaluated using CASP tools. Results: Pooled data from 12 studies (2645 patients) indicated that BoNT-A significantly reduced urgency urinary incontinence (UUI) episodes compared to placebo (p = 0.02) and SNM (p = 0.0008). Additionally, a ≥75% reduction in UUI episodes was more likely with BoNT-A compared to both placebo (p < 0.00001) and SNM (p < 0.00001). Complete resolution of UUI was more likely with BoNT-A compared to placebo (p < 0.00001); however, when compared to SNM, the latter demonstrated a higher rate of complete UUI resolution (p < 0.00001). Patient-reported QoL did not show significant differences between BoNT-A and SNM (p = 0.2). Urinary tract infection (UTI) risk was higher with BoNT-A than both comparators. Conclusions: While BoNT-A offers robust symptom control, its safety profile necessitates careful patient selection. SNM remains a viable alternative for those prioritizing fewer adverse events. The study highlights the need for standardized outcome reporting, long-term cost-effectiveness analyses, and personalized treatment approaches. Full article

Background: Neurogenic bladder (NB) in children may lead to recurrent urinary tract infections (UTIs), renal deterioration, and a reduced quality of life. Clean intermittent catheterization (CIC) is the standard of care, but in some patients, CIC may be unfeasible due to anatomical, sensory, or compliance issues. Button cystostomy (BC) has emerged as a minimally invasive, bladder-preserving alternative. This study aimed to assess the feasibility, safety, and outcomes in the long-term of BC in pediatric NB patients. Methods: Retrospective analysis was conducted on children with NB who underwent endoscopic BC placement between January 2020 and December 2024 in a tertiary pediatric center. Demographic data, operative time, complications, and follow-up outcomes were collected. All procedures used an endoscopic approach with cystoscopic guidance for safe device placement. Results: Thirty-three patients (25 males; median age 7.96 years) underwent BC placement. Most had spinal dysraphism (63.6%). The mean operative time was 48.5 ± 6 min. During a mean follow-up of 2.1 ± 1.4 years, five patients (15.2%) had febrile UTIs and two had minor leakage. No major complications occurred. Four buttons were removed due to clinical improvement (N = 1), the fashioning of a continent derivation (N = 1) and implantation of a sacral neuromodulator (N = 2); two patients accepted CIC. Satisfaction was reported by 93.9% of families. Conclusions: BC is an effective, minimally invasive alternative for urinary drainage in children with NB, even when compared to continent diversion techniques such as the Mitrofanoff, due to its lower invasiveness, greater feasibility, and lower complication rate. Broader adoption may be warranted, but prospective studies are needed to confirm long-term outcomes. Full article

Stress urinary incontinence (SUI) is a common condition that can significantly impair a woman’s quality of life. While initial management includes conservative treatments, surgical options are recommended in refractory cases. Suburethral slings are currently one of the most widely recommended surgical treatments due to their high long-term efficacy. However, complications such as postoperative urinary retention can occur and may lead to chronic voiding dysfunction when not promptly diagnosed and managed. Background/Objectives: The aim of this study was to evaluate the long-term voiding function in women undergoing delayed sling removal or incision for neglected chronic voiding dysfunction. Methods: This retrospective study examined women with chronic voiding dysfunction occurring at least one year after suburethral sling placement for SUI. Preoperative evaluation included comprehensive history, physical examination, urethral ultrasound, uroflowmetry, and urodynamic studies. Surgical interventions consisted of partial or complete sling removal or sling incision (unilateral or bilateral). Postoperative follow-up was conducted at one month and then at 12 months, including clinical examination, ultrasound, and symptom assessment. Results: Sixteen patients were included in the study, all of whom presented with urodynamic confirmation of voiding dysfunction. Following surgical intervention, a significant improvement was observed in voiding symptoms and overall symptoms (p < 0.01). Notably, only one patient experienced persistent voiding difficulties, although complete symptom remission was achieved following sacral neuromodulation. Conclusions: Sling removal or incision has proven to be an effective approach in resolving the majority of cases of neglected chronic voiding dysfunction. These findings suggest that, when appropriately performed, surgical intervention can substantially alleviate symptoms and improve patient well-being, providing an effective therapeutic option for what is often a debilitating condition. Full article

Background: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by persistent bladder-related pain and urinary symptoms, often refractory to conventional treatments. Sacral neuromodulation (SNM) has emerged as a promising therapeutic option for managing refractory IC/BPS. Methods: This retrospective study included 24 patients with IC/BPS treated with SNM between 2017 and 2022. Baseline and follow-up data were collected on pain, opioid use, urinary symptoms, and quality of life. Patients underwent a trial of tonic stimulation before permanent implantation. Continuous variables were reported as median (IQR) and categorical data as counts and percentages. Pre- and post-SNM differences were analyzed using the Wilcoxon rank-sum test. Kaplan–Meier analysis evaluated lead survival, and a Sankey diagram illustrated employment status transitions. Results: Patients had a median age of 54.5 years (IQR: 47–61), with 92% female. Subtypes included Type 1 IC/BPS (8.3%), Type 2 (45.8%), Type 3 (37.6%), and unknown type (8.3%). Median pain duration was 4.5 years (IQR: 3–7.3). SNM resulted in significant improvements in pain (NRS: baseline 8 [IQR: 8–9], last follow-up 3 [IQR: 2–4], p < 0.0001), opioid use (MME: baseline 20 [IQR: 10–40], last follow-up 0 [IQR: 0–10], p < 0.0001), urinary function (24-h voids: baseline 19 [IQR: 14.5–25.8], last follow-up 8 [IQR: 6–12], p < 0.0001), and quality of life (QOL) (EQ-5D-5L: baseline 0.50 [IQR: 0.36–0.56], last follow-up 0.83 [IQR: 0.76–0.89], p < 0.0001). Employment rates increased from 43.5% to 50%, and unemployment decreased from 8.7% to 4.2%. The median follow-up was 35 months (IQR: 28–53). Conclusions: SNM significantly improved pain, urinary symptoms, quality of life, and employment outcomes in patients with refractory IC/BPS. These findings highlight its efficacy as a minimally invasive and reversible option for managing this challenging condition. Full article

Sexual dysfunction following abdominal or pelvic surgery is a significant concern that impacts the quality of life (QoL) for both men and women. This paper explores the multifaceted challenges and re-educational strategies associated with post-surgical sexual dysfunction. It highlights the physical and psychological repercussions of surgeries such as hysterectomies, pelvic organ prolapse repairs, radical prostatectomies, and rectal cancer resections. These procedures often lead to complications like dyspareunia, erectile dysfunction, and altered body image, necessitating comprehensive re-educational approaches. The review emphasizes the importance of tailored interventions, including pelvic floor muscle training (PFMT), biofeedback, manual therapy, and advanced techniques like botulinum toxin injections and sacral neuromodulation. For men, strategies such as phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VEDs), intracavernosal injections, and penile prostheses are explored for their efficacy in restoring erectile function. Psychological support, including cognitive–behavioral therapy and couples counseling, is underscored as essential to addressing emotional and relational aspects of recovery. A multidisciplinary approach involving physiatrists, urologists, gynecologists, physiotherapists, psychologists, and sexual health counselors is advocated for to optimize outcomes. Integrating physical therapy modalities, as well as psychological and relational therapies, into individual rehabilitation projects is crucial for improving sexual function and overall QoL post-surgery. Future research should focus on refining these established strategies and investigating the potential of innovative therapeutic modalities. Full article

Background/Objectives: YouTube is an open-access video streaming platform with minimal regulation which has led to a vast library of unregulated medical videos. This study assesses the quality of information, understandability and actionability of videos on YouTube pertaining to sacral neuromodulation (SNM). Methods: The first 50 videos on YouTube after searching “sacral neuromodulation for bladder dysfunction” were reviewed. Thirty-eight of these videos met the inclusion criteria. These videos were reviewed by two Urology Registrars and the videos were scored using two standardised tools. The DISCERN tool assesses quality of information and the Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-A/V) tool assesses user understandability and accessibility. Results: Forty-two percent of videos were deemed to be poor or very poor, with 58% being fair, good or excellent according to the DISCERN standardised tool. For PEMAT-A/V the average score for understandability was 74% (43–100%) and actionability was 38% (0–100%). We found statistical significance comparing the duration of videos to the DISCERN groups (p = 0.02). We also found significance comparing the understandability of videos using the PEMAT-A/V score to the DISCERN groups (p ≤ 0.05). Conclusions: Forty-two percent of videos on SNM are of poor or very poor quality. The actionability score for consumers to seek out further information is also low at 38%. This raises concerns about the quality of information that is widely available on YouTube and how consumers will use this information when making decisions about their health. Full article

Background: A solid rationale exists for early sacral neuromodulation in the form of causal therapy that improves neurogenic lower urinary tract dysfunction after complete spinal cord injury. However, the short and early time frame for minimally invasive therapy poses a series of ethical and medical issues, which has impeded clinical realisation thus far. Objectives: We performed a cross-sectional study on patients with chronic spinal cord injury to learn about patients’ attitudes towards early treatment to prepare for large randomised controlled trials. Methods: A cohort of patients (n = 86, mixed genders) with spinal cord injury over two years was analysed. Their lower urinary tract-related quality of life was assessed using the Qualiveen-30 tool. The extent of neurogenic lower urinary tract dysfunction, patients’ awareness of it, and their attitude towards early sacral neuromodulation were explored with a specific questionnaire. Results: A total of 61.9% (n = 52) of patients declared that, in retrospect, they would have agreed to early treatment prior to the emergence of their autonomic dysfunction. Of these patients, 51.8% (n = 29) would have also consented to early sacral neuromodulation. Quality of life had no impact on their decision. More than half of the patients (n = 49, 57.0%) stated they had not grasped the momentous nature of neurogenic lower urinary tract dysfunction when being informed about it. This finding was subsequently correlated with a decreased lower urinary tract-related quality of life. Conclusion: Patients with neurogenic lower urinary tract dysfunction are likely to agree to an early therapeutic approach. Clinical implementation requires knowledge and acceptance of the procedure on the part of patients and their caregivers. Full article

Provoked vulvodynia (PV) is the leading cause of vulvar pain and dyspareunia. The etiology of PV is multifactorial and remains poorly understood. PV is associated with a history of repeated vulvar inflammation and is often accompanied by sensory neuromodulation as a result of activation of the metabotropic glutamate receptor 5 (mGluR5) in the sensory nerve terminals. Therefore, this study aims to examine the role of glutamate-mGluR5 signaling during the initial inflammatory phase in chronic vulvar pain development in an animal model of PV.Thermal and mechanical vulvar sensitivity was assessed for three weeks following zymosan vulvar challenges. Anxiety-like behavior and locomotor activity were assessed at the end of the experiment. To investigate the role of glutamate mGluR5, the MTEP (mGluR5 antagonist) was injected into the vulva during vulvar inflammation. On the other hand, glutamate or CHPG (mGluR5 agonist) were injected in order to examine the effects of mGluR5 activation. RT-PCR was performed to assess changes in the transcription of genes related to neuroinflammation, neuromodulation, and neuroplasticity in the spinal cord (L6-S3). Zymosan-induced inflammation resulted in a significant thermal and mechanical vulvar hypersensitivity that persisted for over a month after the zymosan injection. However, local treatment with MTEP enhanced the vulvar mechanical and thermal hypersensitivity. On the other hand, activation of the mGluR5 via injection of glutamate or CHPG into the vulva leads to long-lasting vulvar mechanical and thermal hypersensitivity. The activation of the glutamate pathway was found to be accompanied by an increase in the transcription level of genes related to neuroinflammation and neuroplasticity in the sacral spine region. The present findings indicate that vulvar hypersensitivity is mediated by mGluR5 activation during inflammation. Hence, modulation of the mGluR5 pathway during the critical period of inflammation contributes to preventing chronic vulvar pain development. Conversely, activation of the mGluR5 pathway leads to long-lasting mechanical and thermal hypersensitivity. Full article

Background/Objectives: We have demonstrated in human cadavers and canines that nerve transfer to bladder vesical nerve branches is technically feasible for bladder reinnervation after nerve injury. We further clarify here that sacral (S) ventral rami contribute to these vesical branches in 36 pelvic sides (in 22 human cadavers). Methods: Gross post-mortem visualization and open anterior abdominal approaches were used, as was micro-CT of sacral nerve bundles, for further confirmation when needed. Results: Considerable between and within-subject variation was observed. Sacral (S) ventral rami contributions to vesical nerves were observed as shared contributions from several rami or, in a few cases, from single rami: S2 alone (6%), S3 alone (6%), S2 and S3 (28%), S3 and S4 (28%), S2–S4, 14%, L5 in combination with S1–S4 (6%), S1 and S2 (6%), and S3–S5 (3%). The most common contributor to these shared or single rami contributions was from the S3 ventral ramus, which contributed 100% of the time on the left side and 79% on the right side. Side-to-side asymmetry was observed in 10 of 14 cadavers examined bilaterally (71%). Conclusions: This characterization of the anatomical variation in sacral ventral rami contributions to the bladder will ultimately aid in developing therapeutics for patients with bladder dysfunction. Full article

Sacral spinal cord injury (SSCI) can disrupt bladder neuromodulation and impair detrusor function. Current studies provide limited information on the histologic and genetic changes associated with SSCI-related neurogenic lower urinary tract dysfunction (NLUTD), resulting in few treatment options. This study aimed to establish a simple animal model of SSCI to better understand the disease progression. Ninety 8-week-old Sprague-Dawley (SD) rats were randomly separated into sham operation and SSCI groups. The SSCI group underwent sacral spinal cord injury, while the sham group did not. Urodynamic and histological assessments were conducted at various intervals (1, 2, 3, 4, and 6 weeks) post-injury to elucidate the disease process. Urodynamic examinations revealed significant bladder dysfunction in the SSCI group compared to the sham group, stabilizing around 3–4 weeks post-injury. Histological examination, including hematoxylin–eosin and Masson’s trichrome staining, correlated these functional changes with bladder microstructural alterations. RNA-seq was performed on bladder tissues from the sham group and SSCI group at 6 weeks to identify differentially expressed genes and pathways. Selected genes were further analyzed using polymerase chain reaction (PCR). The findings indicated a pronounced inflammatory response in the first 2 weeks post-SSCI, progressing to bladder fibrosis at 3–4 weeks. In conclusion, this study presents a reliable, reproducible, and straightforward SSCI model, providing insights into bladder functional and morphological alterations post-SSCI and laying the groundwork for future therapeutic research. Full article

Background and Objectives: This review systematically evaluates the potential of electrical neuromodulation techniques—vagus nerve stimulation (VNS), sacral nerve stimulation (SNS), and tibial nerve stimulation (TNS)—as alternative treatments for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s Disease (CD). It aims to synthesize current evidence on the efficacy and safety of these modalities, addressing the significant burden of IBD on patient quality of life and the limitations of existing pharmacological therapies. Materials and Methods: We conducted a comprehensive analysis of studies from PubMed, focusing on research published between 1978 and 2024. The review included animal models and clinical trials investigating the mechanisms, effectiveness, and safety of VNS, SNS, and TNS in IBD management. Special attention was given to the modulation of inflammatory responses and its impact on gastrointestinal motility and functional gastrointestinal disorders associated with IBD. Results: Preliminary findings suggest that VNS, SNS, and TNS can significantly reduce inflammatory markers and improve symptoms in IBD patients. These techniques also show potential in treating related gastrointestinal disorders during IBD remission phases. However, the specific mechanisms underlying these benefits remain to be fully elucidated, and there is considerable variability in treatment parameters. Conclusions: Electrical neuromodulation holds promise as a novel therapeutic avenue for IBD, offering an alternative to patients who do not respond to traditional treatments or experience adverse effects. The review highlights the need for further rigorous studies to optimize stimulation parameters, understand long-term outcomes, and integrate neuromodulation effectively into IBD treatment protocols. Full article

Sacral neuromodulation (SNM) offers a therapeutic approach to urological patients suffering from idiopathic overactive bladder (OAB) syndrome, with or without incontinence and non-obstructive urinary retention (NOR), who are not responding to or are not compliant with conservative or medical therapies. The exact mechanism of action of SNM is not fully understood but modulation of the spinal cord reflexes and brain networks by peripheral afferents is regarded as the main pathway. Over the years, surgical techniques improved, leading to the development of the modern two-stage implantation technique. The quadripolar lead is positioned percutaneously under fluoroscopy guidance through the third sacral foramen following the trajectory of S3. The procedure can be performed under local or general anesthesia with the patient in prone position. Current applications of sacral neuromodulation in urology are increasing thanks to the recent improvements of the devices that make this a valuable option not only in conditions such as overactive bladder and non-obstructing urinary retention but also neurogenic lower urinary tract dysfunction. Full article

Background and Objectives: Chronic pelvic pain (CPP) represents a major public health problem for women with a significant impact on their quality of life. In many cases of CPP, due to gynecological causes—such as endometriosis and vulvodynia—improper pelvic floor muscle relaxation can be identified. Treatment of CPP with pelvic floor hypertonicity (PFH) usually involves a multimodal approach. Traditional magnetic stimulation has been proposed as medical technology to manage muscle hypertonicity and pelvic pain conditions through nerve stimulation, neuromodulation, and muscle relaxation. New Flat Magnetic Stimulation (FMS)—which involves homogeneous rather than curved electromagnetic fields—has the potential to induce sacral S2–S4 roots neuromodulation, muscle decontraction, and blood circulation improvement. However, the benefits of this new technology on chronic pelvic pain symptoms and biometrical muscular parameters are poorly known. In this study, we want to evaluate the modification of the sonographic aspect of the levator ani muscle before and after treatment with Flat Magnetic Stimulation in women with chronic pelvic pain and levator ani hypertonicity, along with symptoms evolution. Materials and Methods: A prospective observational study was carried out in a tertiary-level Urogynaecology department and included women with CPP and PFH. Approval from the local Ethics Committee was obtained before the start of the study (protocol code: MAGCHAIR). At the baseline, the intensity of pelvic pain was measured using a 10 cm visual analog scale (VAS), and patients were asked to evaluate their pelvic floor symptoms severity by answering the question, “How much do your pelvic floor symptoms bother you?” on a 5-answer Likert scale. Transperineal ultrasound (TPU) was performed to assess anorectal angle (ARA) and levator ani muscle minimal plane distance (LAMD). Treatment involved Flat Magnetic Stimulation alone or with concomitant local or systemic pharmacological therapy, depending on the patient’s preferences. FMS was delivered with the DR ARNOLD system (DEKA M.E.L.A. Calenzano, Italy). After the treatment, patients were asked again to score the intensity of pelvic pain using the 10 cm visual analog scale (VAS) and to evaluate the severity of their pelvic floor symptoms on the 5-answer Likert scale. Patients underwent TPU to assess anorectal angle (ARA) and levator ani muscle minimal plane distance (LAMD). Results: In total, 11 patients completed baseline evaluation, treatment, and postoperative evaluation in the period of interest. All patients underwent eight sessions of Flat Magnetic Stimulation according to the protocol. Adjuvant pharmacological treatment was used in five (45.5%) patients. Specifically, we observed a significant increase in both ARA and LAMD comparing baseline and post-treatment measurements (p < 0.001). Quality of life scale scores at baseline and after treatment demonstrated a significant improvement in both tools (p < 0.0001). Conclusions: Flat Magnetic Stimulation, with or without adjuvant pharmacological treatment, demonstrated safety and efficacy in reducing pelvic floor hypertonicity, resulting in improvement in symptoms’ severity and sonographic parameters of muscular spasm. Full article

Background: Functional constipation can lead to painful defecations, fecal incontinence, and abdominal pain, significantly affecting a child’s quality of life. Treatment options include non-pharmacological and pharmacological approaches, but some cases are intractable and require alternative interventions like neuromodulation. A subtype of neuromodulation, called Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS), comprises electrical stimulation at the ankle level, by means of electrodes fixed to the skin. TPTNS is a minimally invasive, easy-to-apply technique that can potentially improve constipation symptoms in the pediatric population by stimulating the sacral nerves. Aim: To evaluate the clinical results and applicability of TPTNS as an adjuvant treatment for children and adolescents with functional constipation. Methods: Between April 2019 and October 2021, 36 patients diagnosed with functional constipation according to the Rome IV Criteria were invited to participate in the study. The study followed a single-center, uncontrolled, prospective cohort design. Patients received TPTNS for 4 or 8 weeks, with assessments conducted immediately after the periods of TPTNS and 4 weeks after the end of the intervention period. The data normality distribution was determined by the Shapiro–Wilk test. The Wilcoxon test and Student’s t-test for paired samples were used to compare quantitative variables, and the McNemar test was used to compare categorical variables. Results: Of the 36 enrolled patients, 28 children and adolescents with intractable function constipation completed the study, receiving TPTNS for 4 weeks. Sixteen patients (57.1%) extended the intervention period for 4 extra weeks, receiving 8 weeks of intervention. TPTNS led to significant improvements in stool consistency, frequency of defecation, and bowel function scores, with a reduction in abdominal pain. Quality of life across physical and psychosocial domains showed substantial enhancements. The quality of life-related to bowel habits also improved significantly, particularly in lifestyle, behavior, and embarrassment domains. The positive effects of this intervention are seen relatively early, detected after 4 weeks of intervention, and even 4 weeks after the end of the intervention. TPTNS was well-tolerated, with an adherence rate of approximately 78%, and no adverse effects were reported. Conclusions: TPTNS is an adjuvant treatment for intractable functional constipation, improving bowel function and quality of life. The effects of TPTNS were observed relatively early and sustained even after treatment cessation. Full article

Lower urinary tract dysfunction (LUTD) has a great effect on patients’ daily life and mental health. Currently, the most mature invasive treatment is sacral neuromodulation (SNM) that needs to be implanted into buttocks and work for 1–2 years. However, most existing SNM stimulators use disposable batteries with a limited lifespan. And existing stimulators are rigid and lack biomechanical compatibility. To address the above problems, wireless power transferring (WPT) is proposed for SNM based on parity–time (PT) symmetry principle to meet buttocks application requirements, where has thick fat and skin tissue. The receiver coil in the SNM stimulator is designed to be as small and flexible as possible to fit implantation. PT technology allows for efficient and stable wireless power transmission without being significantly affected by the misalignment and bending caused by body movement and can penetrate 15 mm fat–skin tissue and achieve 78% transmission efficiency. Furthermore, the flexible wireless sacral nerve stimulator is developed, and the effectiveness of the system is verified. The system could potentially reduce patient discomfort because the implanted device is flexible and can output a stable voltage stimulation signal. Full article