From the Guidelines
Percutaneous Nerve Stimulation (PNS) is not a recommended treatment for neurogenic bladder problems based on the most recent and highest quality study available. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction, published in 2021 in The Journal of Urology 1, does not mention PNS as a treatment option for neurogenic bladder. Instead, the guideline suggests non-surgical and surgical treatment options such as intermittent catheterization, indwelling catheter, botulinum toxin, anticholinergic, beta‐3 agonist, urinary diversion, and bladder augmentation, depending on the patient's level of risk, symptoms, and urodynamic findings.
Key considerations for treating neurogenic bladder include:
- Assessing the patient's level of risk and symptoms
- Evaluating urodynamic findings to determine the best course of treatment
- Considering non-surgical options such as intermittent catheterization and medication
- Reserving surgical options such as urinary diversion and bladder augmentation for more severe cases
It is essential to note that the guideline emphasizes the importance of appropriate follow-up, primarily based on the patient's risk stratification, after treatment 1. This suggests that treatment decisions should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances. In the absence of evidence supporting the use of PNS for neurogenic bladder, other established treatment options should be considered.
From the Research
Treatment Options for Neurogenic Bladder Problems
There are no research papers provided that directly discuss the use of Percutaneous Nerve Stimulation (PNS) for treating neurogenic bladder problems. However, the following information is available on other treatment options for bladder problems:
Bladder Neck Obstruction Treatment
- Alpha-blockers have been shown to be effective in treating functional bladder neck obstruction in women, with improvement in symptoms, maximum flow, and post-void residual urine volume observed in 50-56% of patients 2, 3.
- Bladder neck incision is also a treatment option for functional bladder neck obstruction, with sustained improvement in post-void residual and peak flow observed in patients who underwent the procedure 2, 4.
- Botulinum toxin injection is a minimally invasive treatment option for primary bladder neck obstruction, with subjective improvement observed in 70% of patients and objective improvement observed in 30% of patients 4.
Other Treatment Options
- Alpha1-adrenergic blockers have been shown to be effective in treating primary bladder neck obstruction in young men, with improved urine flow and symptoms observed in 54.2% of patients 5.
- Behavioral treatments, lifestyle modifications, and pelvic floor muscle training are first-line treatment options for non-neurogenic overactive bladder, with oral drugs such as anticholinergics and beta-3-agonists also available for treatment 6.
Key Findings
- The effectiveness of alpha-blockers and bladder neck incision for treating functional bladder neck obstruction has been demonstrated in several studies 2, 4, 3.
- Botulinum toxin injection is a viable treatment option for primary bladder neck obstruction, with both subjective and objective improvements observed in patients 4.
- Alpha1-adrenergic blockers are effective in treating primary bladder neck obstruction in young men, with improved urine flow and symptoms observed in a significant proportion of patients 5.