Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Peripheral nerve stimulation has been used to treat overactive bladder. A possible mechanism of action may be retrograde neuromodulation of the parasympathetic system via the sacral plexus. If the retrograde neuromodulation theory is correct, then stimulation of any nerve not arising from the sacral plexus should not improve overactive bladder symptoms.
CASE REPORT: We present a case of femoral nerve stimulation for neuropathic pain. While the stimulation did not relieve the neuropathic pain, it did successfully treat our patient’s hyperactive bladder.
CONCLUSIONS: The femoral nerve arises in part from L2, the lowest level of the sympathetic system. The sympathetic system is involved with relaxation of the bladder. This report shows that nerves not arising from the sacral plexus can relieve overactive bladder symptomology. A refinement of the retrograde neuromodulation theory may be called for, with the inclusion of sympathetic neuromodulation as an alternative means to treat hyperactive bladder.
KEY WORDS: Overactive bladder, tibial nerve stimulation, femoral nerve stimulation, peripheral nerve stimulation, mechanism of action, case report