Posible mecanismo de acción de la neuromodulación tibial en la hiperactividad del detrusor. Papel de las interneuronas

The possible participation of interneurons in the mechanisms of action of neuromodulation through posterior tibial nerve stimulation for the treatment of overactive bladder syndrome is reviewed. A brief review of the neurophysiology of the lower urinary tract, overactive bladder syndrome, the different neuromodulation techniques for the lower urinary tract, and the participation of the interneurons in the storage-voiding cycle of the bladder are included. We conclude that the antidromic action potential generated by the electrical stimulation for neuromodulation, specifically posterior tibial nerve stimulation, has an inhibitory effect on the detrusor muscle through the spinal interneurons and that the medullary changes (in gene expression and neuropeptides, among others) can prolong its effect. A synergistic inhibition is the result of supraspinal plastic changes, also occurring via the interneurons. Central nervous system plasticity could explain the chronic effect of posterior tibial nerve stimulation and other electrical neurostimulation techniques for the treatment of overactive bladder.