Neural pathway of bellows response during SNM treatment revisited: Conclusive evidence for direct efferent motor response.

Autor: Vaganée D; Department of Urology, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., Voorham J; Department of Urology, Leiden University Medical Center, Leiden, The Netherlands., Panicker JN; Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, United Kingdom., Fransen E; StatUa Center for Statistics, UAntwerpen, Antwerp, Belgium., Voorham-van der Zalm P; Department of Urology, Leiden University Medical Center, Leiden, The Netherlands., Van de Borne S; Department of Urology, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium., De Wachter S; Department of Urology, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Jazyk: angličtina
Zdroj: Neurourology and urodynamics [Neurourol Urodyn] 2020 Jun; Vol. 39 (5), pp. 1576-1583. Date of Electronic Publication: 2020 Jun 02.
DOI: 10.1002/nau.24408
Abstrakt: 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.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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