Transvertebral magnetic neuromodulation for the treatment of overactive bladder: 6 months follow-up
https://doi.org/10.21886/2308-6424-2020-8-4-62-71
Abstract
Introduction. The most common type of lower urinary tract dysfunction is an overactive bladder (OAB). Today there is a need to search for new effective methods of treating this disease.
Purpose of the study. To evaluate the effectiveness of transvertebral magnetic neuromodulation (TMN) of the lumbar spine in patients with OAB.
Materials and methods. 26 patients were enrolled in the clinical study. The treatment course consisted of 15 procedures (3 times a week for 5 weeks). Before and after treatment at 1, 3 and 6 months, complaints were assessed using the ICIQ-SF and OAB-q SF questionnaires. Objective parameters were assessed by urodynamic tests before and 6 months after treatment.
Results. We observed a significant improvement in patients subjective clinical status at all points of assessment. Transvertebral magnetic neuromodulation had the greatest influence on such urodynamic parameters as the first sensation, the first desire, strong desire, maximum cystometric capacity. Patterns of phase hyperactivity were absent in 60.8% of patients after treatment and terminal hyperactivity in 41.7% of patients.
Conclusions. This small study observed a significant therapeutic effect of TMN in patients with OAB. Further large placebo-controlled trials are needed to develop universal effective protocols for lower urinary tract dysfunction treatment.
About the Authors
G V. KovalevRussian Federation
Gleb V. Kovalev — M.D.; Urologist, N.I. Pirogov Clinic of Advanced Medical Technologies; St. Petersburg State University.
199034, St. Petersburg, 7-9 Universitetskaya qy.
tel. +7 (911) 199-72-75
Competing Interests: Authors declare no conflict of interest. Informed consent.
D. D. Shkarupa
Russian Federation
Dmitry D. Shkarupa — M.D., Dr.Sc.(M); Deputy CEO, N.I. Pirogov Clinic of Advanced Medical Technologies; St. Petersburg State University; Head, Northwest Pelvioperinology Centre.
199034, St. Petersburg, 7-9 Universitetskaya qy.
Competing Interests: Authors declare no conflict of interest. Informed consent.
N. D. Kubin
Russian Federation
Nikita D. Kubin — M.D., Dr.Sc.(M); Deputy CEO, N.I. Pirogov Clinic of Advanced Medical Technologies; St. Petersburg State University.
199034, St. Petersburg, 7-9 Universitetskaya qy.
Competing Interests: Authors declare no conflict of interest. Informed consent.
A. O. Zaitseva
Russian Federation
Anastasiya O. Zaytseva — M.D.; Urologist, N.I. Pirogov Clinic of Advanced Medical Technologies; St. Petersburg State University.
199034, St. Petersburg, 7-9 Universitetskaya qy.
Competing Interests: Authors declare no conflict of interest. Informed consent.
I. V. Borodulina
Russian Federation
Irina V. Borodulina — M.D., Cand.Sc.(M); Neurologist, Russian Medical Academy of Continuous Postgraduate Education.
125993, Moscow, 2/1 bld.1 Barrikadnaya st.
Competing Interests: Authors declare no conflict of interest. Informed consent.
P. E. Musienko
Russian Federation
Pavel E. Musienko — M.D., Dr.Sc.(M); Full Prof.; Head, Laboratory of Neuroprostheses, Institute of Translational Biomedicine, St. Petersburg State University; Head, Laboratory of Clinical Neurophysiology and Neurorehabitation Technologies, Academician A.M. Granov Russian Scientific Centre for Radiology and Surgical Technologies; Leading Researcher, Laboratory of Motion Physiology, I.P. Pavlov Institute of Physiology Russian Academy of Sciences.
Saint Petersburg State University
199034, St. Petersburg, 7-9 Universitetskaya qy.; 197758, St. Petersburg, Pesochny sett., 70. Leningradskaya st.; 199034, St. Petersburg, 6 Makarova qy.
Competing Interests: Authors declare no conflict of interest. Informed consent.
References
1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, Van Kerrebroeck P, Victor A, Wein A; Standardisation SubCommittee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37-49. DOI: 10.1016/s0090-4295(02)02243-4
2. Peyronnet B, Mironska E, Chapple C, Cardozo L, Oelke M, Dmochowski R, Amarenco G, Gair^ X, Kirby R, Van Der Aa F, Cornu JN. A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment. Eur Urol. 2019;75(6):988-1000. DOI: 10.1016/j.euru-ro.2019.02.038
3. Chapple CR, Nazir J, Hakimi Z, Bowditch S, Fatoye F, Guelfucci F, Khemiri A, Siddiqui E, Wagg A. Persistence and Adherence with Mirabegron versus Antimuscarinic Agents in Patients with Overactive Bladder: A Retrospective Observational Study in UK Clinical Practice. Eur Urol. 2017;72(3):389-399. DOI: 10.1016/j.eururo.2017.01.037
4. Amundsen CL, Richter HE, Menefee SA, Komesu YM, Arya LA, Gregory WT, Myers DL, Zyczynski HM, Vasavada S, Nolen TL, Wallace D, Meikle SF. OnabotulinumtoxinA vs Sacral Neuromodulation on Refractory Urgency Urinary Incontinence in Women: A Randomized Clinical Trial. JAMA. 2016;316(13):1366-1374. DOI: 10.1001/jama.2016.14617
5. Beaulieu LD, Schneider C. Effects of repetitive peripheral magnetic stimulation on normal or impaired motor control. A review. Neurophysiol Clin. 2013;43(4):251-60. DOI: 10.1016/j.neucli.2013.05.003
6. Galloway NT, El-Galley RE, Sand PK, Appell RA, Russell HW, Carlan SJ. Extracorporeal magnetic innervation therapy for stress urinary incontinence. Urology. 1999;53(6):1108-11. DOI: 10.1016/s0090-4295(99)00037-0
7. Almeida F.G., Bruschini H., Srougi M. Urodynamic and clinical evaluation of 91 patients with urinary incontinence treated with perineal magnetic stimulation: 1-year followup. The Journal of Urology. 2004;171(4):1571-1575. DOI: 10.1097/01.ju.0000117791.72151.f8
8. Yamanishi T, Homma Y, Nishizawa O, Yasuda K, Yokoyama O; SMN-X Study Group. Multicenter, randomized, sham-controlled study on the efficacy of magnetic stimulation for women with urgency urinary incontinence. Int J Urol. 2014;21(4):395-400. DOI: 10.1111/iju.12289
9. He Q, Xiao K, Peng L, Lai J, Li H, Luo D, Wang K. An Effective Meta-analysis of Magnetic Stimulation Therapy for Urinary Incontinence. Scientific Reports. 2019;9(1):9077. DOI: 10.1038/s41598-019-45330-9
10. Sysoev Y, Bazhenova E, Lyakhovetskii V, Kovalev G, Shkor-batova P, Islamova R, Pavlova N, Gorskii O, Merkulyeva N, Shkarupa D, Musienko P. Site-Specific Neuromodulation of Detrusor and External Urethral Sphincter by Epidural Spinal Cord Stimulation. Front Syst Neurosci. 2020;14:47. DOI: 10.3389/fnsys.2020.00047
11. Hou S, Rabchevsky AG. Autonomic consequences of spinal cord injury. Compr Physiol. 2014;4(4):1419-53. DOI: 10.1002/cphy.c130045
12. Rosier PFWM, Schaefer W, Lose G, Goldman HB, Guralnick M, Eustice S, Dickinson T, Hashim H. International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressureflow study. Neurourol Urodyn. 2017;36(5):1243-1260. DOI: 10.1002/nau.23124
13. Barker AT. An introduction to the basic principles of magnetic nerve stimulation. J Clin Neurophysiol. 1991;8(1):26-37. DOI: 10.1097/00004691-199101000-00005
14. Hamada M, Murase N, Hasan A, Balaratnam M, Rothwell JC. The role of interneuron networks in driving human motor cortical plasticity. Cereb Cortex. 2013;23(7):1593-605. DOI: 10.1093/cercor/bhs147
15. Rothkegel H, Sommer M, Paulus W. Breaks during 5Hz rTMS are essential for facilitatory after effects. Clin Neurophysiol. 2010;121(3):426-30. DOI: 10.1016/j.clinph.2009.11.016
16. Yamanishi T, Yasuda K, Suda S, Ishikawa N, Sakakibara R, Hattori T. Effect of functional continuous magnetic stimulation for urinary incontinence. The Journal of Urology. 2000;163(2):456-459. DOI: 10.1016/s0022-5347(05)67899-8
17. Chandi DD, Groenendijk PM, Venema PL. Functional extracorporeal magnetic stimulation as a treatment for female urinary incontinence: ‘the chair'. BJU Int. 2004;93(4):539-42. DOI: 10.1111/j.1464-410x.2003.04659.x
18. Yamanishi T, Yasuda K, Sakakibara R, Suda S, Ishikawa N, Hattori T, Hosaka H. Induction of urethral closure and inhibition of bladder contraction by continuous magnetic stimulation. Neurourol Urodyn. 1999;18(5):505-10. DOI: 10.1002/(sici)1520-6777(1999)18:5<505::aid-nau13>3.0.co;2-8
19. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453-66. DOI: 10.1038/nrn2401
20. Morgan C, de Groat WC, Nadelhaft I. The spinal distribution of sympathetic preganglionic and visceral primary afferent neurons that send axons into the hypogastric nerves of the cat. The Journal of Comparative Neurology. 1986;243(1):23-40. DOI: 10.1002/cne.902430104
21. Kuo DC, Hisamitsu T, de Groat WC. A sympathetic projection from sacral paravertebral ganglia to the pelvic nerve and to postganglionic nerves on the surface of the urinary bladder and large intestine of the cat. J Comp Neurol. 1984;226(1):76-86. DOI: 10.1002/cne.902260106
22. Yokoyama T, Fujita O, Nishiguchi J, Nozaki K, Nose H, Inoue M, Ozawa H, Kumon H. Extracorporeal magnetic innervation treatment for urinary incontinence. Int J Urol. 2004;11(8):602-6. DOI: 10.1111/j.1442-2042.2004.00857.x
23. Sinha S, Lakhani D, Singh VP. Cough associated detrusor overactivity in women with urinary incontinence. Neurourol Urodyn. 2019;38(3):920-926. DOI: 10.1002/nau.23928
Review
For citations:
Kovalev G.V., Shkarupa D.D., Kubin N.D., Zaitseva A.O., Borodulina I.V., Musienko P.E. Transvertebral magnetic neuromodulation for the treatment of overactive bladder: 6 months follow-up. Urology Herald. 2020;8(4):62-71. (In Russ.) https://doi.org/10.21886/2308-6424-2020-8-4-62-71