Abstract
Twenty patients with chronic suprasacral spinal cord injury presenting with detrusor hyperreflexia were examined. In a preliminary study in ten patients we investigated the reproducibility of bladder capacity through the repetition of three cystometries. The effect of electrical stimulation (ES) on detrusor hyperreflexia was then investigated in ten patients during three consecutive cystometries, the first one without ES (baseline) and the other two with continuous ES of the dorsal penile or clitoris nerve via surface electrodes. Parameters of stimulation were 5 Hz frequency, 0.50 msec pulse duration, and stimulation strength of 1 and 2 times the bulbocavernosus reflex threshold.
No significant differences in bladder capacity were found between the three consecutive cystometries without ES (respectively 97.0 ml, 101.5 ml and 105.6 ml). A current at the bulbocavernosus threshold (mean 24.4 mA) failed to induce a significant increase in bladder capacity compared to baseline (173.0 ml vs 155.5 ml, P = 0.17) whereas a current of twice the bulbocavernosus threshold (mean 48.9 mA) was highly significant (318.5 ml vs 155.5 ml, P< 0.007). ES of twice the threshold resulted in perineal contraction in all of the patients, the threshold ES never did.
Our results emphasise the decisive roles of perineal contraction and of current strength for achieving short-term bladder inhibition in spinal cord injury patients. The carry-over effect may also be dependent on the current strength. If so, maximal pudendal ES could represent an alternative procedure in the treatment of detrusor hyperreflexia in these patients.
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Godec C, Cass A S, Ayala G F . Bladder inhibition with functional electrical stimulation. Urology 1975; 6: 663–666.
Godec C, Cass A S . Electrical stimulation for voiding dysfunction after spinal cord injury. J Urol 1979; 121: 73–75.
Janez J, Plevnik S, Suhel P . Urethral and bladder responses to anal electrical stimulation. J Urol 1979; 122: 192–194.
Merrill D C . The treatment of detrusor incontinence by electrical stimulation. J Urol 1979; 122: 515–517.
Vereecken R L, Das J, Grisar P . Electrical sphincter stimulation in the treatment of detrusor hyperreflexia of paraplegics. Neurourol Urodyn 1984; 3: 145–154.
Vodusek D B, Light J K, Libby J M . Detrusor inhibition induced by stimulation of pudendal nerve afferents. Neurourol Urodyn 1986; 5: 381–389.
Wheeler J S, Walter J S, Zaszczurynski P J . Bladder inhibition by penile nerve stimulation in spinal cord injury patients. J Urol 1992; 147: 100–103.
Prévinaire J G, Soler J M, Boileau G, Chelihi D, Delahaye H, Schumacker P, Vanvelcenaher J, Vanhée J L, Perrigot M . Effet à court terme de l'électrostimulation cutanée du nerf pudendal sur l'hyperactivité vésicale chez le blessé médullaire. Ann Réadaptation Méd Phys 1995; 38: 211–216.
Susset J G . Cystometry. In: Krane RJ, Siroky MB (eds). Clinical Neurourology. 2nd edn. Little, Brown: Boston 1991, pp 163–184.
Grynderup V . Double cystometry in the uninhibited neurogenic bladder. Acta Neurol Scand 1966; 42: 67–77.
Jensen D . Pharmacological studies of the uninhibited neurogenic bladder. Acta Neurol Scand 1981; 64: 145–174.
Soler J M, Andoque F, Bouffard-Vercelli M, Perrigot M . Reproductibilité des cystomanométries et sphinctérométries à eau des blessés vertébro-médullaires. A propos de 30 cas. Sifud Cannes, 1989; 2: 146–149.
Tang P C, Ruch T C . Non-neurogenic basis of bladder tone. Am J Phyiol 1955; 181: 249–257.
Edvardsen P . Nervous control of urinary bladder in cat. I. The collecting phase. Acta Physiol Scand 1968; 72: 157–171.
de Groat W C, Lalley P M . Reflex firing in the lumbar sympathetic outflow to activation of vesical afferent fibres. J Physiol 1972; 226: 289–309.
de Groat W C, Booth A M, Yoshimura N . Neurophysiology of micturition and its modification in animal models of human disease. In: Maggi CA (ed). The autonomic nervous system: Nervous control of the urogenital system, vol 3. Harwood Academic Publishers: London 1993, pp 227–290.
Fall M, Erlandson B E, Carlsson C A, Lindström S . The effect of intravaginal electrical stimulation on the feline urethra and urinary bladder. Neuronal mechanisms. Scand J Urol Nephrol 1978; Supp 44: 19–30.
Lindström S, Fall M, Carlsson C A, Erlandson B E . The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation. J Urol 1983; 129: 405–410.
Ohlsson B L, Fall M, Frankenberg-Sommar S . Effects of external and direct pudendal nerve maximal electrical stimulation in the treatment of the uninhibited overactive bladder. Br J Urol 1989; 64: 374–380.
Mathias C J, Frankel H L . Clinical manifestations of malfunctioning sympathetic mechanisms in tetraplegia. J Auton Nerv Syst 1983; 7: 303–312.
Prévinaire J G, Soler J M, Hanson P . Skin potential recordings during cystometry in spinal cord injured patients. Paraplegia 1993; 31: 13–21.
Schurch B, Yasuda K, Rossier A B . Detrusor bladder neck dyssynergia revisited. J Urol 1994; 152: 2066–2070.
Bors E . Segmental and peripheral innervation of the urinary bladder. J Nerv Ment Dis 1952; 116: 572–578.
Denny-Brown D, Robertson E G . On the physiology of micturition. Brain 1933; 56: 149–190.
Teague C T, Merrill D C . Electric pelvic floor stimulation. Mechanism of action. Invest Urol 1977; 15: 65–69.
Wheeler J S, Walter J S, Sibley P . Management of incontinent SCI patients with penile stimulation: preliminary results. J Am Paraplegia Soc 1994; 17: 55–59.
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Prévinaire, J., Soler, J., Perrigot, M. et al. Short-term effect of pudendal nerve electrical stimulation on detrusor hyperreflexia in spinal cord injury patients: importance of current strength. Spinal Cord 34, 95–99 (1996). https://doi.org/10.1038/sc.1996.17
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DOI: https://doi.org/10.1038/sc.1996.17
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