Non-invasive transcutaneous electrical stimulation in the treatment of overactive bladder.
Non-invasive transcutaneous electrical stimulation in the treatment of overactive bladder.
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DOI：
10.1016/j.ajur.2015.04.013
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发表时间：
2015-04
影响因子：
2.6
通讯作者：
Barker AT
中科院分区：
文献类型：
--
作者：
Slovak M;Chapple CR;Barker AT
我们回顾了经皮神经电刺激(TENS)用于治疗膀胱过度活动症(OAB)症状的文献，重点介绍了刺激部位、刺激参数、被认为是靶向的神经结构以及所取得的临床和尿动力学结果。大多数研究使用了骶神经或胫神经刺激。文献表明，虽然TENS疗法可能有神经调节作用，但患者不太可能从单一应用TENS中获得显著的好处，事实上，急性研究尚未报道明显的好处。在长期研究中，对刺激强度、治疗策略和电极位置的描述存在差异，患者的各种症状和病理也不同。此外，大多数研究都是非对照的，因此没有评估安慰剂的效果。人们对这些疗法起作用的潜在机制知之甚少，因此确切地说需要刺激哪些结构，以及使用什么参数。有很有希望的证据表明经皮刺激方法的有效性，但有必要对刺激标准和结果测量进行充分的标准化，以确定实施这种疗法的最佳方式并记录其疗效。
We reviewed the literature on transcutaneous electrical nerve stimulation (TENS) used as a therapy for overactive bladder (OAB) symptoms, with a particular focus on: stimulation site, stimuli parameters, neural structures thought to be targeted, and the clinical and urodynamic outcomes achieved. The majority of studies used sacral or tibial nerve stimulation. The literature suggests that, whilst TENS therapy may have neuromodulation effects, patient are unlikely to benefit to a significant extent from a single application of TENS and indeed clear benefits from acute studies have not been reported. In long-term studies there were differences in the descriptions of stimulation intensity, strategy of the therapy, and positioning of the electrodes, as well as in the various symptoms and pathology of the patients. Additionally, most studies were uncontrolled and hence did not evaluate the placebo effect. Little is known about the underlying mechanism by which these therapies work and therefore exactly which structures need to be stimulated, and with what parameters. There is promising evidence for the efficacy of a transcutaneous stimulation approach, but adequate standardisation of stimulation criteria and outcome measures will be necessary to define the best way to administer this therapy and document its efficacy.