Acute Autonomic Nervous System Response to Direct Sacral Nerve Root Stimulation in Lower Urinary Tract Dysfunction: A New Approach to Understand the Mechanism of Action of Sacral Nerve Modulation

No AccessJournal of UrologyAdult Urology23 May 2024Acute Autonomic Nervous System Response to Direct Sacral Nerve Root Stimulation in Lower Urinary Tract Dysfunction: A New Approach to Understand the Mechanism of Action of Sacral Nerve Modulation Xavier Biardeau, Anne Wojtanowski, Sam Tilborghs, Julien De Jonckheere, Patrick Vermersch, and Stefan De Wachter Xavier BiardeauXavier Biardeau Corresponding Author: Xavier Biardeau, Department of Urology, Claude Huriez Hospital, 1 Rue Michel Polonovski, 59037Lille Cedex, France (email protected) https: //orcid. org/0000-0003-1270-7401, Anne WojtanowskiAnne Wojtanowski, Sam TilborghsSam Tilborghs, Julien De JonckheereJulien De Jonckheere, Patrick VermerschPatrick Vermersch, and Stefan De WachterStefan De Wachter View All Author Informationhttps: //doi. org/10. 1097/JU. 0000000000004027AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: Our goal was to assess acute autonomic nervous system (ANS) response to direct sacral nerve root (SNR) stimulation in the context of lower urinary tract dysfunction. Material and Methods: In this retrospective monocentric study, patients undergoing 2-stage sacral nerve modulation for overactive bladder, nonobstructive urinary retention, or chronic bladder pain syndrome between March 2022 and June 2023 were analyzed. A standardized stimulation protocol was applied during the lead implantation, each of the 4 contact points being sequentially stimulated at the amplitude required to elicit anal motor response. Stimulations were labeled as StimA, StimB, StimC, and StimD, ordered by ascending order of minimum amplitude required for anal motor response. Heart rate variability parameters were collected using PhysioDoloris Monitor, and computed through the time-domain (standard deviation of normal-to-normal intervals SDNN, root mean square of successive differences), the frequency-domain (low frequency, high frequency) and the graphical (Analgesia Nociception Index ANI) methods. Results: Fifty patients were analyzed, including 35 females. Twelve patients had an underlying neurological disease. Efficacy was deemed achieved in 54% of patients. SDNN variability significantly increased during StimA to StimC, while maximum SDNN significantly increased only during StimA. ANI variability significantly increased during all 4 stimulations, while maximum ANI significantly increased only during StimA. Conclusions: Direct stimulation of SNR is responsible for a significant increase in ANS and relative parasympathetic nervous system activity, with a greater effect observed when the stimulation was delivered closer to the SNR. These results shed light on potential mechanisms underlying sacral nerve modulation, particularly regarding the treatment of ANS dysregulation in lower urinary tract dysfunction. REFERENCES 1. . Electrical stimulation in the clinical management of the neurogenic bladder. J Urol. 1988; 140 (6): 1331-1339. doi: 10. 1016/s0022-5347 (17) 42038-6 Link, Google Scholar 2. . 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Annu Int Conf IEEE Eng Med Biol Soc. 2009; 2009: 1840-1843. doi: 10. 1109/IEMBS. 2009. 5332598 Crossref, Medline, Google Scholar Funding/Support: None. Conflict of Interest Disclosures: Dr Biardeau reported receiving funding from Medtronic, Coloplast, Hollister, Convatec, Abbvie, and Ipsen. Dr Vermersch reported receiving honoraria for contributions to meetings from Biogen, Sanofi-Genzyme, Novartis, Teva, Merck, Roche, Imcyse, AB Science, Janssen, and BMS-Celgene. No other disclosures were reported. Ethics Statement: The protocol has been declared to the French Advisory Committee on Information Processing in Material Research in the Field of Health (Commission Nationale Informatique et Liberté—CNIL) under the No. DEC22-285 and has been accepted by the Urology Research Ethics Committee (Comité d'Ethique de la Recherche en Urologie—CERU) under the No. CERU₂023020. Author Contributions: Conception and design: Biardeau, Vermersch, De Wachter. Data analysis and interpretation: Biardeau, Wojtanowski, Tilborghs, De Jonckheere, Vermersch, De Wachter. Data acquisition: Biardeau, De Wachter. Drafting the manuscript: Biardeau, Wojtanowski, De Wachter. Critical revision of the manuscript for scientific and factual content: Tilborghs, De Jonckheere, Vermersch, De Wachter. Statistical analysis: Wojtanowski. Supervision: Biardeau, Tilborghs, De Jonckheere, Vermersch, De Wachter. Data Availability: The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. © 2024 by American Urological Association Education and Research, Inc. FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc. Keywordselectric stimulation therapyautonomic nervous systemparasympathetic nervous systemheart rate variabilityanalgesia nociception indexhigh frequency variability indexsacral neuromodulationMetrics Author Information Xavier Biardeau Corresponding Author: Xavier Biardeau, Department of Urology, Claude Huriez Hospital, 1 Rue Michel Polonovski, 59037Lille Cedex, France (email protected) More articles by this author Anne Wojtanowski More articles by this author Sam Tilborghs More articles by this author Julien De Jonckheere More articles by this author Patrick Vermersch More articles by this author Stefan De Wachter More articles by this author Expand All Funding/Support: None. Conflict of Interest Disclosures: Dr Biardeau reported receiving funding from Medtronic, Coloplast, Hollister, Convatec, Abbvie, and Ipsen. Dr Vermersch reported receiving honoraria for contributions to meetings from Biogen, Sanofi-Genzyme, Novartis, Teva, Merck, Roche, Imcyse, AB Science, Janssen, and BMS-Celgene. No other disclosures were reported. Ethics Statement: The protocol has been declared to the French Advisory Committee on Information Processing in Material Research in the Field of Health (Commission Nationale Informatique et Liberté—CNIL) under the No. DEC22-285 and has been accepted by the Urology Research Ethics Committee (Comité d'Ethique de la Recherche en Urologie—CERU) under the No. CERU₂023020. Author Contributions: Conception and design: Biardeau, Vermersch, De Wachter. Data analysis and interpretation: Biardeau, Wojtanowski, Tilborghs, De Jonckheere, Vermersch, De Wachter. Data acquisition: Biardeau, De Wachter. Drafting the manuscript: Biardeau, Wojtanowski, De Wachter. Critical revision of the manuscript for scientific and factual content: Tilborghs, De Jonckheere, Vermersch, De Wachter. Statistical analysis: Wojtanowski. Supervision: Biardeau, Tilborghs, De Jonckheere, Vermersch, De Wachter. Data Availability: The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Advertisement PDF downloadLoading. . .