Neuromodulation -neue Techniken

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• 作者：K. Heinze ; A. van Ophoven
• 关键词：Neuromodulation ; laparaskopische ; Neuromodulation ; pudendale ; Neuromodulation ; sakrale ; N.?pudendus ; Harnblasenfunktionsst?rung ; Urinary bladder function disorders ; Neuromodulation ; laparoscopic ; Neuromodulation ; sacral ; Neuromodulation ; pudendal ; Pudendal nerve
• 刊名：Der Urologe A
• 出版年：2015
• 出版时间：March 2015
• 年：2015
• 卷：54
• 期：3
• 页码：373-377
• 全文大小：341 KB
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Urology and Andrology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-0563

文摘

Neuromodulative procedures have become an inherent component in the therapy of functional urinary bladder and pelvic floor function disorders. Sacral neuromodulation has been used in Germany for more than 20 years and reresents the standard neuromodulative therapy. Technical improvements in the field of test stimulation and the phasing out of the large pulse generator models represent current changes with the resulting advantages and disadvantages. Pudendal neuromodulation (PNM) has been known for many years as a procedure for treatment of chronic diseases of the urinary bladder and the lesser pelvis and is predominantly used as second-line neuromodulative therapy; however, for pelvic pain syndromes and in particular for pudendal neuralgia, it represents a promising minimally invasive first-line therapy. Due to the technically demanding puncture procedure, PNM has so far only been used in Germany in specialized centers. Through the development of new operation techniques, the prerequisites for a wider multicentric use, with the future aim of approval of the procedure, have been achieved. External transdermal pudendal neuromodulation is a promising therapeutic approach and after further testing in randomized studies could find an application as a conservative step before minimally invasive pudendal neuromodulation. Although the technique of laparoscopic electrode placement on neural structures of the lesser pelvis is technically attractive, it predominantly finds a monocentric use and must in due course be critically compared with established minimally invasive procedures.