THE STIMULATION OF THE GENITAL NERVE – GNS
Overactive bladder (OAB) is a condition that affects millions of citizen worldwide. Main objectives of the therapy are to control the bladder muscle activity and the urinary incontinence (urge incontinence). Electrical stimulation has emerged as an alternative and attractive treatment for refractory cases of bladder overactivity. The stimulation of pelvic nerve is an innovative treatment based on the stimulation of the pudendal nerve or it urethral branch – the genital nerve, the key player in bladder and the urethral sphincter control. The electrical stimulation induce a relaxation of the bladder muscle, and a contraction/closure of the urethral sphincter. While other therapeutic approaches present side effects such as an impairment of the bladder voiding function, the presented method do not disturb the normal bladder emptying, or even may improve it.
The GNS Therapy is based on the stimulation of the genital nerve while the PN-Stim-LION procedure is focuses on the stimulation of the pudendal nerve, which nerve is the key player in bladder, rectum and sphincters control. In both technique a small electrode wire with a small pacemaker less than 8mm are placed to the nerve to be stimulated. In both techniques the device is placed within the pelvic cavity that protect the electrode from migration.
The thin wire (less than 1mm in diameter) emits a harmless and painless electrical pulse that stimulates the nerve, resulting in:
- a contraction of the urethral sphincter
- a relaxation of the urinary bladder
- a better bladder control for a better emptying of the bladder.
The stimulation of the pudendal nerve – the PN-Stim-LION procedure
The implantation to the pudendal nerve required a well experience in laparoscopic pelvic surgery. From medical point of view, the laparoscopic procedure present the great advantage of the feasibility of exploring the pelvic cavity before decision for implantation is made. This in turn offer the gynecologist the discovery of a possible cause for the condition: endometriosis of the bladder, bowel adhesions to the bladder or compression/irritation of the pelvic nerves are all potential causes for overactive bladder that can be treated the laparoscopic way (avoiding need for stimulation or other symptomatic treatments). The laparoscopic procedure take less than 30 minutes and can be done in “day-case”. After the laparoscopic implantation of the wire to the pudendal nerve, the patient will undergo a test-phase of several weeks with an external stimulator, before decision of implantation a permanent pacemaker in local anesthesia is made. The stimulation modulates the nerves with mild electrical pulses. The patient control the time and level of stimulation by using a control remoter.
The stimulation of the genital nerve – GNS therapy
When no any etiology is suspected, the first technique of choice is the GNS – A Microstimulator System of of few millimeters is implanted behind the pubic bone to the genital nerve. The procedure required as small skin incision hidden by the pubic hairs and can be done under local anesthesia. Using a control remoter, stimulation of the genital nerve reduce the bladder overactivity and control the urinary incontinence at same time. This procedure take less than 30 minutes, can be performed in day-case. The procedure is easy to performed by gynecologist or urologist.
Behind the positive effect on bladder function, stimulation of the genital nerve also improve sexual satisfaction and clitoris/penis erection.
Both procedures are reversible and can be discontinued at any time by turning off (control remoter) or removing the device.