Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.

JU INSIGHT Autonomic Nervous System Response to Sacral Nerve Stimulation in Lower Urinary Tract Dysfunction

By: Xavier Biardeau, MD, University of Lille, CHU Lille, France, University of Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, France; Anne Wojtanowski, INSERM CIC-IT 1403, CHU Lille, France; Sam Tilborghs, MD, Antwerp University Hospital, Edegem, Belgium, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wirijk, Belgium; Julien De Jonckheere, PhD, INSERM CIC-IT 1403, CHU Lille, France; Patrick Vermersch, MD, PhD, University of Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, France; Stefan De Wachter, MD, PhD, Antwerp University Hospital, Edegem, Belgium, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wirijk, Belgium | Posted on: 14 Aug 2024

Biardeau X, Wojtanowski A, Tilborghs S, De Jonckheere J, Vermersch P, De Wachter S. Autonomic nervous system response to sacral nerve stimulation in lower urinary tract dysfunction: a new approach to understand the mechanism of action of sacral nerve modulation. J Urol. 2024;212(2):000-000. doi:10.1097/JU.0000000000004027

Study Need and Importance

The role of the autonomic nervous system (ANS) in the mechanism of action of sacral nerve modulation (SNM), particularly in the context of lower urinary tract dysfunction (LUTD), has received limited consideration and lacks specific investigation. Nonetheless, it is important to remember that the ANS—through the balance between the sympathetic nervous system (SNS) and the parasympathetic nervous system (PSNS)—plays a pivotal role in regulating the micturition cycle and is believed to contribute to some LUTD.

What We Found

In this study, we assessed the acute ANS response to direct sacral nerve root (SNR) stimulation during quadripolar lead SNM implantation under general anesthesia, analyzing heart rate variability during a standardized stimulation protocol (Figure). Among the 50 patients included, 28 were implanted to treat overactive bladder (OAB), 21 to treat nonobstructive urinary retention, and 1 to treat chronic bladder pain syndrome. We reported a significant modification in overall ANS activity and in relative PSNS activity on the 3 contact points positioned closest to the SNR. We also reported a significant increase in overall ANS activity and in relative PSNS activity only when the stimulation was delivered at the level of the contact point positioned closest to the SNR.

image

Figure. Standardized sacral nerve root stimulation protocol. CP indicates contact point; TAW, time-analysis window; WOP, washout period.

Limitations

This retrospective study encompassed a relatively heterogeneous population undergoing 2-stage SNM for various neurogenic and nonneurogenic LUTD. While we have standardized the patient clinical pathway, significant variations undoubtedly persist, particularly concerning anesthesia protocols, that could have potentially impacted the outcomes.

Interpretation for Patient Care

Recent research, using heart rate variability or even skin sympathetic response, has provided insights into abnormally heightened SNS activity among individuals with OAB. Thus, SNM could potentially improve OAB, and maybe other LUTD, by rebalancing the ANS notably by increasing PSNS activity and counteracting the SNS hyperactivity.

advertisement

advertisement