urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2022-10-3-106-121urovest-586Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS ARTICLEВозможности нейромодуляции при нейрогенной дисфункции нижних мочевыводящих путейNeuromodulation possibilities in neurogenic lower urinary tract dysfunctionhttps://orcid.org/0000-0003-2011-1253ЯринГ. Ю.YarinG. Yu.

Геннадий Юрьевич Ярин — кандидат медицинских наук; врач-уролог, онколог, директор по развитию

630084, Россия, г. Новосибирск, ул. Дениса Давыдова, д. 12

Gennadiy Yu. Yarin — M.D., Сand.Sc.(Med); Development Director, Urologist, Oncologist

12 Denis Davydov St., Novosibirsk, 630084, Russian Federation

89331000333@ya.ruhttps://orcid.org/0000-0001-8207-3809КрейдинЕ. И.KreydinE. I.

Евгений Иванович Крейдин — врач-уролог

1441 Eastlake Ave., Лос Анджелес, Калифорния, 90033, США

Evgeniy I. Kreydin — M.D.; Urologist

1441 Eastlake Ave, Los Angeles, CA, 90033, USA

kreydin@usc.eduhttps://orcid.org/0000-0002-7128-6400СалюковР. В.SalyukovR. V.

Роман Вячеславович Салюков — кандидат медицинских наук; доцент кафедры эндоскопической урологии и ультразвуковой диагностики

117198, Россия, г. Москва, ул. Миклухо-Маклая, д. 6

Roman V. Salyukov — M.D., Cand.Sc.(Med); Assoc.Prof., Dept. of Endoscopic Urology and Ultrasound Diagnostics, Faculty of Continuing Medical Education

Miklukho-Maklaya St., Moscow, 117198, Russian Federation

salyukov2012@yandex.ruhttps://orcid.org/0000-0003-3279-2682КасатоноваЕ. В.KasatonovaE. V.

Елена Владимировна Касатонова — научный сотрудник отдела андрологии и репродукции человека

105425, Россия, г. Москва, ул. Парковая 3-я, д. 51, стр. 15 ФГБОУ ВО «Новосибирский государственный

Elena V. Kasatonova — Researcher, Assoc.Sc., Division of Andrology and Human Reproduction

51 3rd Parkovaya St., Moscow, 105425, Russian Federation

kasatonova@yandex.ruhttps://orcid.org/0000-0001-5251-5362АстраковС. В.AstrakovS. V.

Сергей Викторович Астраков — доктор медицинских наук, доцент; заведующий кафедрой анестезиологии и реаниматологии

630091, Россия, г. Новосибирск, Красный проспект, д. 52

Sergey V. Astrakov — M.D., Dr.Sc.(Med), Assoc.Prof.(Docent); Head, Dept. of Anesthesiology and Intensive Care

52 Krasny Ave., Novosibirsk, 630091, Russian Federation

astr_sv@mail.ruhttps://orcid.org/0000-0002-5256-8410БершадскийА. В.BershadskyA. V.

Артём Валерьевич Бершадский — кандидат медицинских наук; врач-уролог отделения медицинской реабилитации

620102, Россия, г. Екатеринбург, ул. Серафимы Дерябиной, д. 34

Artem V. Bershadsky — M.D., Cand.Sc.(Med); Urologist, Division of Medical Rehabilitation

34 S. Deryabina St., Yekaterinburg, 620102, Russian Federation

natsia@gmail.comhttps://orcid.org/0000-0001-7769-6147ВильгельмиИ. А.VilgelmiI. A.

Инна Александровна Вильгельми — гинеколог, онколог, генеральный директор

630084, Россия, г. Новосибирск, ул. Дениса Давыдова, д. 12

Inna A. Vilgelmi — M.D.; CEO, Gynecologist, Oncologist

12 Denis Davydov St., Novosibirsk, 630084, Russian Federation

vilgelmi@ngs.ruhttps://orcid.org/0000-0002-3164-9377ШевелаА. И.ShevelaA. I.

Андрей Иванович Шевела — доктор медицинских наук, профессор; заместитель директора по научной работе

630090, Россия, г. Новосибирск, пр. Ак. Лаврентьева, д. 8

Andrey I. Shevela — M.D., Dr.Sc.(Med), Full Prof.; Deputy Director for Science

8 Acad. Lavrentieva Ave., Novosibirsk, 630090, Russian Federation

info@cnmt.ruООО «Альянс хирургов»Россия«Alliance of Surgeons», LLCRussian FederationДепартамент урологии, Медицинская школа Университета Южной КалифорнииСоединённые Штаты АмерикиDepartment of Urology, Keck School of Medicine, University of Southern CaliforniaUnited StatesФГАОУ ВО «Российский университет дружбы народов»РоссияPeoples' Friendship University of Russia (RUDN University)Russian FederationНИИ урологии и интервенционной радиологии им. Н.А. Лопаткина — филиал ФГБУ «НМИЦ радиологии» Минздрава РоссииРоссияLopatkin Scientific Research Institute of Urology and Interventional Radiology — branch of the National Medical Research Radiological CenterRussian FederationФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава РоссииРоссияNovosibirsk State Medical UniversityRussian FederationГБУЗ СО «Центральная городская клиническая больница № 6 г. Екатеринбург»РоссияYekaterinburg Central City Clinical Hospital No. 6Russian FederationФГБУН Институт химической биологии и фундаментальной медицины СО РАНРоссияInstitute of Сhemical Biology and Fundamental Medicine — the Siberian Branch of the RASRussian Federation202201102022103106121Copyright © Ярин Г.Ю., Крейдин Е.И., Салюков Р.В., Касатонова Е.В., Астраков С.В., Бершадский А.В., Вильгельми И.А., Шевела А.И., 20222022Ярин Г.Ю., Крейдин Е.И., Салюков Р.В., Касатонова Е.В., Астраков С.В., Бершадский А.В., Вильгельми И.А., Шевела А.И.Yarin G.Y., Kreydin E.I., Salyukov R.V., Kasatonova E.V., Astrakov S.V., Bershadsky A.V., Vilgelmi I.A., Shevela A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/586Введение

Введение. Нейромодуляция хорошо зарекомендовала себя в лечении пациентов с идиопатическим гиперактивным мочевым пузырём и необструктивной задержкой мочи, резистентных к консервативной терапии. Возможное применение метода в популяции пациентов с нейрогенной дисфункцией нижних мочевых путей (НДНМП) представляет безусловный клинический интерес.

Цель исследования

Цель исследования. Провести анализ современных возможностей и особенностей нейромодуляции в когорте пациентов с НДНМП.

Материалы и методы

Материалы и методы. При написании литературного обзора были использованы оригинальные материалы исследований, опубликованные в базах данных PubMed, научной электронной библиотеки России (еLibrary), SciVerse (ScienceDirect), Scopus, Medline, EMBASE, веб-сайтах профессиональных ассоциаций без ограничений по дате публикаций. Для цитирования было отобрано 60 источников, преимущество было отдано систематическим обзорам, метаанализам и РКИ.

Результаты

Результаты. Применительно к НДНМП рассмотрены транскраниальная и периферическая магнитная стимуляция, интравезикальная электростимуляция, тибиальная, пудендальная электростимуляция и стимуляция дорсального полового нерва, а также сакральный и эпидуральный методы электростимуляции.

Заключение

Заключение. В современной литературе оптимистически представлен опыт использования нейромодуляции в популяции больных НДНМП с набольшей доказательной базой для инвазивной сакральной и тибиальной стимуляций. При формировании рекомендаций стоит учитывать, что исследования построены на гетерогенных популяциях, ограничены малыми размерами выборок с недостаточной описательной частью степени и тяжести неврологических заболеваний. Тем не менее, нехватка других подходящих методов лечения и многообещающие первоначальные результаты указывают на важность дальнейших усилий по совершенствованию применяемых методов нейромодуляции. Необходимы дальнейшие исследования с большим размером выборки, лучшей классификацией заболеваний и контролируемым дизайном исследований.

Introduction

Introduction. Neuromodulation has proven itself in the treatment of patients suffering from idiopathic overactive bladder and non-obstructive urinary retention, who are resistant to conservative therapy. The possible use of the method in the population of patients with neurogenic lower urinary tract dysfunction (NLUTD) is of undoubted clinical interest.

Objective

Objective. To analyze the current possibilities and features of neuromodulation in a cohort of patients with NLUTD.

Materials and methods

Materials and methods. Original research materials published in the PubMed, eLibrary, SciVerse (ScienceDirect), Scopus, Medline, EMBASE databases, websites of professional associations without restrictions on the date of publication were used. Sixty sources were selected for citation, with preference given to systematic reviews, meta-analyses and RCTs .

Results

Results. In relation to NLUTD, transcranial and peripheral magnetic stimulation, intravesical electrical stimulation, tibial, pudendal electrical stimulation, and stimulation of the dorsal pudendal nerve, as well as sacral and epidural methods of neurostimulation are considered.

Conclusion

Conclusion. The current literature optimistically presents the experience of using neuromodulation in the NLUTD patient population with the largest evidence base for invasive sacral and tibial stimulation. The studies are based on heterogeneous populations, limited by small sample sizes with insufficient descriptive part of the degree and severity of neurological diseases, and it should be considered when forming guidelines. However, the lack of other suitable therapies and promising initial results indicate the importance of further efforts to improve the applied methods of neuromodulation. Further studies are needed with larger sample sizes, better classification of diseases, and controlled study design

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The authors declare that there are no conflicts of interest present.