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ELECTRICAL NEUROSTIMULATION AND NEUROMODULATION OF VOIDING DYSFUNCTIONS AND PELVIC PAIN

This chapter discusses electrical neurostimulation and neuromodulation of voiding dysfunctions and pelvic pain. Interest in the electrical control of bladder dysfunction began in the 1950s. Most reports concerned the stimulation of the detrusor directly or the spinal cord. Only a few discussed pelvic or sacral nerve stimulation. Direct pelvic nerve stimulation initially demonstrated encouraging results in animal experiments; however, in humans, parasympathetic innervation is unsuitable for direct electrode application. Direct detrusor stimulation, which has the advantage of easy electrode placement and high specificity of target organ, was unsuccessful because of fibrosis, and electrode malfunction from bladder movement and bladder erosion. External surface electrodes and implantable electrodes to stimulate the spinal cord failed to achieve bladder emptying. Although the precise mechanism of normal bladder control remains unclear, it is generally accepted that normal micturition depends on a balance between excitatory and inhibitory descending pathways and feedback from afferents in the effector organs bladder and urethra. Electrostimulation has been applied through various approaches: externally by perineal needles, surface electrodes, electric pessaries and anal plugs, and internally by electrode implants in the pelvic floor muscles.

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