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Neuromodulation for overactive bladder

机译：膀胱过度活动症的神经调节

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Overactive bladder (OAB) affects millions of people worldwide yet first-line treatments are often poorly tolerated and compliance rates are low. Neuromodulation works via afferent nerve modulation and offers a minimally invasive and reversible alternative treatment option for patients with OAB who have failed first-line therapy. Neuromodulation has revolutionized the management of OAB and is now well established as a safe and effective treatment for those refractory to conservative treatments. Multiple neuroanatomical pathways have been described for sacral neuromodulation including the S3 nerve root, pudendal nerve and tibial nerve. The S3 nerve root is currently the main treatment target and has the most long-term data on safety and efficacy to support its use. However, studies on neuromodulation at the pudendal nerve or posterior tibial nerve have been positive and their role in treatment continues to evolve. Most urologists who are experienced in voiding dysfunction can become proficient in each technique. Patient selection, surgical techniques and postoperative management differ slightly between approaches and urologists should familiarize themselves with these differences. Treatment of OAB should progress from the least to most invasive modality, and neuromodulation provides an attractive option owing to its minimally invasive approach, tolerability, positive outcomes and reversibility.
机译：膀胱过度活动症（OAB）影响着全球数百万人，但一线治疗通常耐受性差，依从性较低。神经调节通过传入神经调节起作用，并且为一线治疗失败的OAB患者提供了一种微创和可逆的替代治疗选择。神经调节彻底改变了OAB的管理方法，现已被确立为对保守治疗无效的患者的安全有效的治疗方法。已经描述了neuro神经调节的多种神经解剖通路，包括S3神经根，阴部神经和胫神经。 S3神经根目前是主要治疗目标，并且在安全性和有效性方面拥有最长期的数据来支持其使用。然而，关于阴部神经或胫后神经的神经调节的研究是积极的，其在治疗中的作用还在不断发展。具有排尿功能障碍经验的大多数泌尿科医生可以精通每种技术。病人的选择，手术技术和术后处理在方法之间略有不同，泌尿科医师应熟悉这些差异。 OAB的治疗应从侵入性最小的方法发展到侵入性最大的方法，并且由于其微创方法，耐受性，阳性结果和可逆性，神经调节提供了一个有吸引力的选择。

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