Title
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Optimization of electrical stimulation/modulation therapies in the management of neurogenic and non-neurogenic lower urinary tract dysfunction
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Author
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Abstract
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Even though it corresponds to the alternation between a bladder filling phase and a bladder emptying phase, the normal micturition cycle cannot be summed up as a binary operation but involves the constant consideration of multiple factors: the filling level of the bladder reservoir, the safety of the environment in which we live, the emotional context in which we evolve and the social constraints to which we are subjected. We now know that there are alterations and/or modifications in brain activity and connectivity, as well as changes in the regulation of the autonomic nervous system (ANS), in certain types of lower urinary tract dysfunctions - notably in overactive bladder or urge urinary incontinence and in certain types of voiding dysfunctions. Among the therapies available today, electrical modulation/stimulation therapies (tibial neurostimulation and sacral neuromodulation) appear able to normalize and/or modify brain activity and connectivity, as well as the ANS balance. They could thus provide, at least, a partial response to some of the etiopathogenies underlying these lower urinary tract dysfunctions. However, the deployment and positioning of these electrical modulation/stimulation therapies are still limited by an incomplete understanding of their mechanisms of action, imperfect identification of the indications and populations most likely to benefit from these therapies, a lack of consensus on the setting of the electrical current delivered, and a lack of medium and long-term evaluation. In the first part, we questioned the indications for these therapies, and particularly their place as a preventive approach for lower urinary tract dysfunctions due to spinal cord injury. We also questioned the relation, in terms of efficacy, between transcutaneous tibial neurostimulation and sacral neuromodulation, to better support patients in shared decision making process. Finally, we developed the first tool to predict the success of sacral neuromodulation as a treatment for voiding dysfunction. In the second part, we questioned the mechanisms of action, and more specifically the changes in the balance of the ANS in response to an acute sacral root stimulation. In the third part, we questioned the mid-term follow-up (5 years) after definitive implantation of sacral neuromodulation in a geographic population pool, looking for risk factors for discontinuation of follow-up. These data, although still to be supplemented by future research projects, will enable us to further optimize electrical modulation/stimulation therapies in the management of neurogenic and non-neurogenic lower urinary tract dysfunctions. |
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Language
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English
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Publication
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Lille
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Université de Lille & Universiteit Antwerpen
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2024
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DOI
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10.63028/10067/2058690151162165141
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Volume/pages
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239 p.
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Note
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Vermersch Patrick [Supervisor]
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De Wachter, Stefan [Supervisor]
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Full text (open access)
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