High Frequency Sacral Root Nerve Block Allows Bladder Voiding

Neurourol Urodyn, 2012 · DOI: 10.1002/nau.21075 · Published: June 1, 2012

Simple Explanation

Following spinal cord injury, uncoordinated bladder and sphincter activity can prevent voiding. This study investigates whether blocking nerve conduction in the sacral roots using kilohertz frequency (KF) electrical stimulation can prevent sphincter activation and allow bladder voiding. The S2 sacral nerve roots were stimulated to generate bladder pressure, while one S1 nerve root was stimulated to evoke EUS pressure, simulating dyssynergic reflexes. KF waveforms were applied to an electrode implanted on the S1 nerve root to block nerve conduction. The study found that applying KF waveforms increased bladder voiding, suggesting that sacral nerve block can prevent EUS activation and allow complete bladder voiding, potentially eliminating the need for surgical neurotomy.

Study Duration

Not specified

Participants

6 cats

Evidence Level

Not specified

Key Findings

1
Applying KF waveforms increased bladder voiding in single trials from 3 ± 6% to 59 ± 12%.
2
Voiding could be increased to 82 ± 9% of the initial bladder volume by repeating or increasing the duration of the trials.
3
Bladder voiding during KF stimulation was equivalent to unobstructed bladder voiding.

Research Summary

This study investigated the use of kilohertz frequency (KF) electrical conduction block of the sacral roots to prevent external urethral sphincter (EUS) activation and allow bladder voiding in cats. The results showed that applying KF waveforms increased bladder voiding significantly, suggesting that sacral nerve block can prevent EUS activation and allow complete bladder voiding. The authors concluded that sacral KF block neuroprostheses could increase patient acceptance of bladder voiding neuroprostheses, reducing patient morbidity and cost of care by eliminating the requirement for surgical rhizotomies.

Practical Implications

Improved Neuroprosthetics

Sacral nerve block can be used in bladder voiding neuroprostheses, potentially eliminating the need for a neurotomy.

Reduced Morbidity

Eliminating neurotomy requirements could increase patient acceptance of bladder voiding neuroprostheses.

Reduced Healthcare Costs

Increasing patient acceptance of bladder voiding neuroprostheses could reduce the cost of patient care.

Study Limitations

1
Block could not be achieved in one animal.
2
Sacral stimulation evoked minimal bladder pressure in one animal, prevented voiding although EUS block was complete.
3
The remaining animal did not void during Max Voiding trials due to a urethral obstruction despite sufficient bladder pressure, even under deep anesthesia.

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