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Neuromodulation bei Harnblasenfunktionsstörungen

Neuromodulation of lower urinary tract dysfunction

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Zusammenfassung

Neuromodulationsverfahren wie die transkutane elektrische Nervenstimulation (TENS), die transkutane/perkutane tibiale Nervenstimulation (TTNS/PTNS) und die sakrale Neuromodulation (SNM) stellen bei therapierefraktären Harnblasenfunktionsstörungen im Sinne einer Zweitlinientherapie eine vielversprechende therapeutische Möglichkeit dar. Es können sowohl Harnblasenspeicher- als auch Harnblasenentleerungsstörungen therapeutisch angegangen werden und oft lassen sich auch Darmfunktionsstörungen erfolgreich behandeln. Der Wirkmechanismus der Neuromodulation ist nicht gänzlich geklärt, doch Afferenzen dürften eine Schlüsselrolle spielen. So scheint es via periphere Afferenzen (genital/rektal bei TENS, tibial bei TTNS/PTNS und sakral bei SNM) zu einer Modulation von Rückenmarksreflexen und Gehirnzentren zu kommen. Mit der Neuromodulation kann auch in den aussichtslosesten Situationen oft eine erstaunliche Wirkung erzielt werden, und es ist mit einer relevanten Weiterentwicklung dieser Therapieverfahren zu rechnen, die künftig eine immer bedeutendere Rolle in der Urologie spielen dürften.

Abstract

Neuromodulative procedures such as transcutaneous electrical nerve stimulation (TENS), transcutaneous/percutaneous tibial nerve stimulation (TTNS/PTNS), and sacral neuromodulation (SNM) are promising second-line treatments for refractory lower urinary tract dysfunction. Using these therapies, both storage and voiding disorders but also bowel dysfunction might be successfully treated. Although the mechanism of action of neuromodulation is not well understood, it seems to involve modulation of spinal cord reflexes and brain networks by peripheral afferents (genital/rectal, tibial and sacral afferents in the case of TENS, TTNS/PTNS, and SNM, respectively). Neuromodulative procedures might also be highly effective in the most desperate situations and further relevant developments are expected so that these innovative techniques will most likely become even more important in urology.

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Authors and Affiliations

  1. Neuro-Urologie, Zentrum für Paraplegie, Universitätsklinik Balgrist, Universität Zürich, Forchstraße 340, 8008, Zürich, Schweiz

    T. M. Kessler

  2. Department of Urology, University Hospital Antwerp, University of Antwerp, Antwerpen, Belgien

    S. de Wachter

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Correspondence to T. M. Kessler.

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T. M. Kessler und S. de Wachter geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kessler, T.M., de Wachter, S. Neuromodulation bei Harnblasenfunktionsstörungen. Urologe 56, 1591–1596 (2017). https://doi.org/10.1007/s00120-017-0526-x

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