Die sakrale Nervenstimulation zur Behandlung von Blasenfunktionsstörungen nach Rückenmarksverletzungen: aktueller Stand und Perspektiven

Zusammenfassung

Neben sozialen und bekannten medizinischen Problemen können Rückenmarksverletzungen zahlreiche urologische Funktionsstörungen verursachen. Neben einer Detrusorhyperreflexie entwickelt sich zusätzlich eine Detrusor-Sphinkter-Dyssenergie, die mit rezidivierenden Harnwegsinfekten, Urolithiasis, vesikoureteralem Reflux, und konsekutiv mit zum Teil irreversiblen Nierenparenchymschädigungen einhergehen kann. Während des letzten Jahrzehntes wurden mit unterschiedlichen Erfolgsraten zahlreiche neue experimentelle Techniken für die Neurostimulation der Sakralwurzeln entwickelt. Die Neuromodulation der Sakralwurzel ist eines der innovativen Konzepte zur Behandlung diverser Blasenspeicher- und Blasenentleerungsstörungen. Die Indikationen zur Neuromodulation werden dabei ständig erweitert und modifiziert, so dass viele diagnostische Entitäten wie Urge- und sensorische Inkontinenz, idiopathische chronische Harnretention, Beckenschmerzen und interstitielle Zystitis erfasst werden können. Trotz der erheblichen Menge an Beiträgen aus der Forschung und der Klinik, welche die verschiedenen Modalitäten in der Anwendung der Elektrostimulation oder -modulation zur Behandlung von Blasenentleerungsstörungen untersuchen, erscheinen die Daten noch immer unvollständig. Die Neurostimulation der Sarkralwurzeln ist eine einfache Technik mit hoher Selektivität, die ein hohes Potential für zukünftige klinische Anwendungen hat. Weitere Untersuchungen zu den neuropathologischen Veränderungen nach Diskonnektion des sakralen Miktionszentrums vom höher gelegenen Zentrum, und stetige Verbesserungen der Stimulationssysteme werden dieser Technik in der Zukunft zum Erfolg verhelfen.

Abstract

Spinal cord injury, beside its social and medical problems, has many urologic complications. Detrusor hyperreflexia and detrusor sphincter dyssynergia develop with repeated urinary tract infection, stone formation, vesicoureteral reflux, renal parenchymal loss and renal failure. Over the last decade, there are many reports about new experimental techniques for application of neurostimulation to the sacral roots with variable success rate. Sacral root neuromodulation is one of the relatively recent concepts for the treatment of various voiding and storage dysfunctions. The indications of neuromodulation have been extended to include many diagnostic entities including urge and sensory incontinence, idiopathic chronic urinary retention, pelvic pain and interstitial cystitis. Despite the extensive amount of research and clinical papers cited in this article and others concerning the different modalities for application of electrostimulation or electromodulation to recuperate the bladder function and decrease its outlet resistance, the overall results are still supoptimal. We believe that a simple technique of sacral root neurostimulation with high selectivity and long term results will be optimal for future human application. Further exploration of neuropathological changes and understanding the possible reflex mechanism after disconnection of sacral micturition center from its higher control with continous improvement of the stimulation system and electric waveforms will help solve many current problems.

Key words:

Urinary tract - Spinal cord injuries - Sacral - Neurostimulation

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