Electrical stimulation in the treatment of bladder dysfunction: technology update

Figures & data

Table 1 Treatment options for overactive and underactive bladder

Type of dysfunction	Overactive bladder			Underactive bladder
	Symptoms	Treatment (idiopathic)	Treatment (neurogenic)	Symptoms	Treatment (idiopathic)	Treatment (neurogenic)
Storage	Urgency Urgency urinary incontinence Increased daytime frequency Nocturia	Lifestyle intervention Pharmacotherapy SNM Intradetrusor botulinum toxin A Surgical interventions	Pharmacotherapy Intradetrusor botulinum toxin Surgical intervention	–	–	–
Voiding	–	–	–	Slow stream Hesitancy Straining to void Feeling of incomplete bladder emptying	Pharmacotherapy Clean intermittent catheterization Indwelling catheter Surgical intervention	Pharmacotherapy Clean intermittent catheterization Indwelling catheter Surgical intervention

Abbreviaton: SNM, sacral neuromodulation.

Table 2 Introduction and approval of sacral neuromodulation and tibial nerve stimulation

Modality	Subtype	First introduced	FDA approved	CE mark	Longevity
SNM	Non-rechargeable	1979	1997	1994	3–5 years
	Rechargeable	2016	–	2016	15 years
Tibial nerve stimulation	Non-implantable	1983	2005	2005	–
	Implantable	2010	2018 (approval for study design)	2016	–

Abbreviatons: SNM, sacral neuromodulation; FDA, Food and Drug Administration (USA); CE, Conformité Européenne (Europe).

Figure 1 Anterior fluoroscopy of an implanted rechargeable SNM. The arrowhead points to the four electrodes.

Abbreviaton: SNM, sacral neuromodulation.

Table 3 Stimulation parameters of electrical stimulation modalities for bladder dysfunction

Modality	Amplitude	Frequency	Pulse width
SNM	1.7 mA	14.3 Hz	210.6 µs
PTNS	9 mA, 0.5–15 mA	20 Hz, 40 Hz µs	200, 800 µs
Intravesical stimulation	1–30 mA	5–50 Hz	200–800 µs
Pudendal nerve stimulation	25–35 mA	2.5 Hz	–
Saphenous nerve stimulation	47.7 mA	20 Hz	200 µs
TENS	16 mA, 20 mA	5–75 Hz	200–1500 µs
Brindley	10–40 V	2–53 Hz	0–720 µs
TMS	–	1 Hz, 5 Hz	–

Abbreviatons: SNM, sacral neuromodulation; PTNS, percutaneous tibial nerve stimulation; TENS, transcutaneous electrical nerve stimulation; TMS, transcranial magnetic stimulation.