Neurourology and urodynamics · 2020
Neural pathway of bellows response during SNM treatment revisited: Conclusive evidence for direct efferent motor response.
СтатьяНазвание и аннотация: Перевод в очереди
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Vaganée Donald, Voorham Jeroen, Panicker Jalesh N, Fransen Erik, Voorham-van der Zalm Petra, Van de Borne Sigrid, De Wachter Stefan
Аннотация
BACKGROUND: In sacral neuromodulation (SNM) patients, it is thought the bellows response elicited upon sacral spinal nerve stimulation is reflex-mediated. Therefore the mechanism of action of SNM is considered to be at the spinal or supraspinal level. These ideas need to be challenged.
OBJECTIVE: To identify the neural pathway of the bellows response upon sacral spinal nerve stimulation.
DESIGN, SETTING, AND PARTICIPANTS: Single tertiary center, prospective study (December 2017-June 2019) including 29 patients with overactive bladder refractory to first-line treatment.
INTERVENTION: Recording of the pelvic floor muscle response (PFMR) using a camcorder and electromyography (EMG) (intravaginal probe and concentric needles) upon increasing stimulation during lead or implantable pulse generator placement.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The lowest stimulation intensity needed to elicit a visual PFMR and electrical PFMR was determined. Electrical PFMRs were subdivided according to their latency.
OUTCOME: the association between visual and electrical PFMRs. Statistical analyses were performed using the weighted kappa coefficient.
RESULTS: Three different electrical PFMRs could be identified by surface and needle EMG, corresponding with a direct efferent motor response (R1), oligosynaptic (R2), and polysynaptic (R3) afferent reflex response. Only the R1 electrical PFMR was perfectly associated with the visual PFMR (κ = 0.900).
CONCLUSIONS: The visual PFMRs upon sacral spinal nerve stimulation are direct efferent motor responses. A reopening of the discussion on the mechanism of action of SNM is possibly justified.
OBJECTIVE: To identify the neural pathway of the bellows response upon sacral spinal nerve stimulation.
DESIGN, SETTING, AND PARTICIPANTS: Single tertiary center, prospective study (December 2017-June 2019) including 29 patients with overactive bladder refractory to first-line treatment.
INTERVENTION: Recording of the pelvic floor muscle response (PFMR) using a camcorder and electromyography (EMG) (intravaginal probe and concentric needles) upon increasing stimulation during lead or implantable pulse generator placement.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The lowest stimulation intensity needed to elicit a visual PFMR and electrical PFMR was determined. Electrical PFMRs were subdivided according to their latency.
OUTCOME: the association between visual and electrical PFMRs. Statistical analyses were performed using the weighted kappa coefficient.
RESULTS: Three different electrical PFMRs could be identified by surface and needle EMG, corresponding with a direct efferent motor response (R1), oligosynaptic (R2), and polysynaptic (R3) afferent reflex response. Only the R1 electrical PFMR was perfectly associated with the visual PFMR (κ = 0.900).
CONCLUSIONS: The visual PFMRs upon sacral spinal nerve stimulation are direct efferent motor responses. A reopening of the discussion on the mechanism of action of SNM is possibly justified.