PTNS — Onderwijs

@MRVANBALKEN

Titel nascholing, dd-mm-jjjj

Disclosure M.R. van Balken

(potentiële) belangenverstrengeling Zie hieronder

Voor bijeenkomst mogelijk relevante relaties met bedrijven Astellas, Pfizer, Goodlife, Uroplasty, GSK.

• Sponsoring of onderzoeksgeld• Honorarium of andere (financiële)

vergoeding• Aandeelhouder• Andere relatie, namelijk …

• (Onderzoeks)consulent• Congres-bezoek• Voordrachten

Onderwijs 10-10-2014

Richtlijn Neurogeen Blaaslijden

EAU Guideline Neuro-urology

Textbook of Fem. Urology & Urogynecology

Gebruikt:

Richtlijn Urine Incontinentie

PTNS - wat is het?

PTNS - wat mag je verwachten?

PTNS - werking?

PTNS - bij instabiliteiten?

PTNS - positie OAB-behandelingen?

PTNS - bij neurogeen blaaslijden?

PTNS - toekomst?

Vast:- 20 Hz- 0.2 msec- 9 V

Variabel:- 0-10 mA

https://www.youtube.com/watch?v=Z4VC19mboTk

12 wekelijkse sessies

elke 2 weken

elke 3 weken

elke 4 weken

….

PTNS - wat is het?

PTNS - wat mag je verwachten?

PTNS - werking?

PTNS - bij instabiliteiten?

PTNS - positie OAB-behandelingen?

PTNS - bij neurogeen blaaslijden?

PTNS - toekomst?

J Urol. 2010 Apr;183(4):1438-43. doi: 10.1016/j.juro.2009.12.036. Epub 2010 Feb 20.

Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial.Peters KM1, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, Macdiarmid SA.

Author information

AbstractPURPOSE:The Study of Urgent PC vs Sham Effectiveness in Treatment of Overactive Bladder Symptoms (SUmiT) was a multicenter, double-blind, randomized, controlled trial comparing the efficacy of percutaneous tibial nerve stimulation to sham through 12 weeks of therapy. The improvement in global response assessment, voiding diary parameters, and overactive bladder and quality of life questionnaires was evaluated.

MATERIALS AND METHODS:A total of 220 adults with overactive bladder symptoms were randomized 1:1 to 12 weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy. Overactive bladder and quality of life questionnaires as well as 3-day voiding diaries were completed at baseline and at 13 weeks. Subject global response assessments were completed at week 13.

PTNS - wat is het?

PTNS - wat mag je verwachten?

PTNS - werking?

PTNS - bij instabiliteiten?

PTNS - positie OAB-behandelingen?

PTNS - bij neurogeen blaaslijden?

PTNS - toekomst?

Carry-over effect: negative modulation of excitatory synapses in the central micturition reflex pathway

PTNS - wat is het?

PTNS - wat mag je verwachten?

PTNS - werking?

PTNS - bij instabiliteiten?

PTNS - positie OAB-behandelingen?

PTNS - bij neurogeen blaaslijden?

PTNS - toekomst?

Urology. 2008 Apr;71(4):641-5. doi: 10.1016/j.urology.2007.11.135.

Acute effect of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with multiple sclerosis: urodynamic study.Kabay SC1, Yucel M, Kabay S.

PTNS - wat is het?

PTNS - wat mag je verwachten?

PTNS - werking?

PTNS - bij instabiliteiten?

PTNS - positie OAB-behandelingen?

PTNS - bij neurogeen blaaslijden?

PTNS - toekomst?

PTNS - wat is het?

PTNS - wat mag je verwachten?

PTNS - werking?

PTNS - bij instabiliteiten?

PTNS - positie OAB-behandelingen?

PTNS - bij neurogeen blaaslijden?

PTNS - toekomst?

4.2.2.1.2 Peripheral temporary electrostimulation

Percutaneous tibial nerve stimulation and external temporary electrical stimulation (e.g. penile/clitoral or intracavital) suppress neurogenic DO during acute stimulation (35,36). Both techniques have also demonstrated sustained prolonged effects (3 months and 1 year, respectively) in patients with neurogenic bladder dysfunction due to MS (37-39).

LUT function remained improved 2 years after transcutaneous electrical stimulation of the bladder in patients with SCI (40). Electrostimulation may also improve continence for at least 3 months in children with MMC (41).

EAU Guideline Neuro-urology

6.2.2.2.2 Niet-chronische elektrische stimulatieBij niet-chronische elektrische stimulatie wordt gebruikt gemaakt van een tijdelijk apparaat buiten het lichaam wat elektrische pulsen stuurt naar zenuwen die de blaasfuncties regelen.

Er werden therapeutische effecten gezien na stimulatie van de nervus tibialis posterior (PTNS) bij multiple sclerose (MS) patiënten [69]. Echter, acute effecten tijdens urodynamisch onderzoek werden wisselend aangetoond in deze patiëntengroep [70-71] (LE: 2b).

Richtlijn Neurogeen Blaaslijden

PTNS - wat is het?

PTNS - wat mag je verwachten?

PTNS - werking?

PTNS - bij instabiliteiten?

PTNS - positie OAB-behandelingen?

PTNS - bij neurogeen blaaslijden?

PTNS - toekomst?

Neurourol Urodyn. 2013 Jun;32(5):472-5. doi: 10.1002/nau.22322. Epub 2012 Oct 15.

Urgent-SQ implant in treatment of overactive bladder syndrome: 9-year follow-up study.

Janssen DA, Farag F, Heesakkers JP.Source

Department of Urology, Radboud University, Nijmegen Medical Centre, Geert Grooteplein Zuid, Nijmegen, The Netherlands. d.janssen@uro.umcn.nl

Abstract

AIMS:

Electrical stimulation of the posterior tibial nerve (PTN) is an established therapy for the treatment of refractory overactive bladder syndrome (OAB). The Urgent-SQ™ is an implant that is surgically placed near the PTN and activated by an external pulse generator, allowing for "on demand" PTN stimulation, without the need for needle insertion. The current study presents results of a 9-year, open-label, follow-up of eight patients to address the long term safety and efficacy of the implant.

METHODS:

In 2003, eight patients with refractory OAB received a Urgent-SQ™ implant and were systematically followed up for 1 year. After that, the follow up continued as open-label study. The seven patients who still had the implant were contacted after 9 years and evaluated with an interview, physical exam, ankle X-ray, voiding diaries, and completed questionnaires about adverse events, performance, efficacy, safety, and quality of life (validated iQoL).

RESULTS:

Six of the seven patients still had sensory and loco-motor responses on stimulation at 9-year follow-up. Three of four patients who had a successful treatment response at 1 year, still use the device. The fourth patient restarted therapy. The implants are intact with no migration and/or displacement. All patients reported easy handling of the Urgent-SQ™. One patient reported sporadic spontaneous sensory responses. One patient reported occasional localized ankle discomfort.

CONCLUSIONS:

After 9 years of clinical experience, we demonstrated that implant driven PTNS with the Urgent-SQ™ is a safe therapy for OAB. The implant has a long lifespan and is well tolerated by patients.