NEUROMODULATION AND OTHER ELECTROSTIMULATORY TECHNIQUES

Neuromodulation and neurostimulation have evolved from experimental techniques to clinical practice. The majority of implantations are still performed in specialised units and centers but an increasing number of implants are performed worldwide with excellent success. However both techniques using electrical current as the driving force make use of different mechanisms and, hence, address different categories of patients. Electrical stimulation of the anterior roots of the sacral nerves is used to provoke bladder contraction as a direct effect of nerve stimulation. High amplitudes are necessary and therefore the technique is limited to patients with a spinal cord injury. Neuromodulation uses a modulatory effect of electrical current on the controlling reflexes of the lower urinary tract inflow into the central nervous system. Therefore this technique can be used in conditions seemingly as different as overactive bladder or non-contracting bladder. The excellent clinical results with long-term follow-up makes these techniques a valuable contribution in the field of neuro-urology.