Semiconditional Electrical Stimulation of Pudendal Nerve Aff erents Stimulation to Manage Neurogenic Detrusor Overactivity in Patients with Spinal Cord Injury

Ann Rehabil Med, 2011 · DOI: http://dx.doi.org/10.5535/arm.2011.35.5.605 · Published: October 1, 2011

Simple Explanation

Neurogenic detrusor overactivity is defi ned as involuntary detrusor contraction induced due to a neurological condition during the fi lling phase of the bladder. When control function in the cerebrum and the pons is blocked due to injury of the spinal cord above the sacral cord, the bladder becomes overactive, resulting in urinary incontinence and frequency. Clean intermittent catheterization, parasympathetic blocking agents and other bladder muscle relaxants are used most frequently as the current treatment of choice for neurogenic detrusor overactivity in spinal cord injuries (SCI). In this study, semiconditional electrical stimulation on dorsal penile aff erent nerve could inhibit the neurogenic detrusor overactivity and increase the bladder volume in SCI patients with variable level and severity, eff ectively.

Study Duration

September 2002 to February 2007

Participants

40 patients (36 males, 4 females) with spinal cord injury

Evidence Level

Not specified

Key Findings

1
Among the 40 subjects, 35 patients showed neurogenic detrusor overactivity in the CMG study. Among these 35 patients, detrusor overactivity was suppressed eff ectively by pudendal nerve aff erent electrical stimulation in 32 patients.
2
Th e infusion volume until the occurrence of the fi rst refl ex contraction (Vini) was 99.4±80.3 ml. Th e volume of saline infused to the bladder until the last contraction suppressed by semiconditional pudendal nerve stimulation (Vmax) was 274.3±93.2 ml, which was significantly greater than Vini.
3
In patients with good response to the pudendal nerve aff erent stimulation, the bladder volume signifi cantly increased by stimulation in all the patients.

Research Summary

This study evaluated the effect of semiconditional electrical stimulation of the pudendal nerve afferents for neurogenic detrusor overactivity in patients with spinal cord injury. Semiconditional stimulation was the programmed current delivery which started with the first bladder contraction, and continued in cyclic pattern with preset on-off duration. In this study, semiconditional electrical stimulation on dorsal penile aff erent nerve could inhibit the neurogenic detrusor overactivity and increase the bladder volume in SCI patients with variable level and severity, eff ectively.

Practical Implications

Clinical Application

Semiconditional electrical stimulation to the pudendal nerve effectively suppressed unwanted bladder contraction and increased bladder volume.

Alternative Treatment

Electrical stimulation treatment may be applied as an alternative to other methods, such as drug treatment or surgery, for managing voiding dysfunction.

Personalized Management

The management of neurogenic bladder should be individualized to help each patient effectively, and should be performed by designing tests suitable to the special needs of each patient.

Study Limitations

1
Performing 3 consecutive CMGs with 30 minute intervals in a day.
2
Sequential CMGs could aff ect responses of the detrusor muscle.
3
Delayed effect of semiconditional stimulation to the pudendal nerve and results of the long-term trial should be studied carefully for further clinical application of our results.

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