Study design: Retrospective case series. Objectives: The primary aim was to assess the clinical effects of sacral neuromodulation (SNM) for neurogenic bladder and/or bowel dysfunction with multiple symptoms secondary to spinal cord disease or injury. Setting: Beijing, China. Methods: Between 2011 and 2013, 23 patients with multiple bladder and/or bowel problems secondary to spinal cord disease or injury were treated with a preliminary test SNM. If at least 50% clinical improvement occurred, then the patient underwent a permanent SNM procedure. We evaluated the patients using a bladder diary, post-void residual volume measurement and the Wexner questionnaire score for constipation before the test phase, during the test phase and after the permanent SNM. Results: In the test phase, the rate of improvement in dysuria (29.4%) was significantly lower than urgency frequency (64.7%), urinary incontinence (69.2%) and constipation (75.0%). An implant was performed in 13 (56.5%) patients, including 4 patients who still used intermittent catheterization to exclude urine after permanent SNM because the symptom of dysuria could not be improved significantly and 1 patient who achieved X50% improvement in lower urinary tract dysfunction but not in constipation. During follow-up (17.5 ± 2.0 months), 1 patient (7.7%) failed and 1 patient had bilateral vesicoureteral reflux. Conclusion: Chronic SNM cannot always resolve all the bladder and bowel symptoms secondary to spinal cord disease or injury, but combined with other treatments may help improve multiple symptoms.
Study design: The study was designed as a single-arm clinical trial. Objectives: To investigate the effect of detrusor botulinum toxin A (BoNTA) injection on urinary tract infection (UTI) in patients with spinal cord injury (SCI). Setting: The study was performed in a national rehabilitation research center of China. Methods: Between September 2010 and May 2012, 41 male inpatients with neurogenic detrusor overactivity (NDO) caused by traumatic SCI, mean age 36.0 ± 8.8 years, duration of SCI since inclusion 21.5 ± 17.3 months, received an injection of 300 U BoNTA into detrusor. Before and 3 months after injection, each patient kept a bladder diary, underwent video-urodynamic investigation and urine culture. All UTIs occurring in the 6 months before and the 6 months after injection were recorded. Results: Before injection, the mean number of UTI over 6 months was 1.39 ± 1.36. After injection, the mean significantly decreased to 0.78 ± 0.96 (P ¼ 0.023). The mean maximum detrusor pressure during filling decreased significantly in the patients of detrusor overactivity (n ¼ 24) compared with patients of normo-active detrusor (n ¼ 17) after injection (35.4±12.2 vs 20.9±7.9 cmH 2 O, P ¼ 0.000), meantime, the decrease of UTI was significant in the former (1.29±1.21 vs 0.41±0.62 cmH 2 O, P ¼ 0.015) while no significant in the latter (1.46 ± 1.47 vs 1.04 ± 1.08, P ¼ 0.319). Conclusion: Detrusor BoNTA injection significantly decreased UTI in SCI patients with NDO. This effect seems to be related to the decrease of detrusor pressure.
Objectives: To determine the inhibitory effects of pudendal nerve stimulation (5 Hz) on bladder overactivity at the early stage of spinal cord injury (SCI) in dogs, and to explore the possible effects on delayed progression of bladder fibrosis after SCI. Methods: The study was performed using six dogs with spinal cord transection at the T9-T10 level. Group 1 (three dogs) underwent low-frequency electrical stimulation of the pudendal nerve 1 day after spinal cord transection. Group 2 (three dogs) underwent only spinal cord transection. All dogs underwent urodynamic examination at 1 and 3 months after SCI. The bladders were removed for histological examination of fibrosis at 3 months after SCI. Results: Bladder capacity and compliance were significantly increased (Po0.05) by pudendal nerve stimulation in group 1 when compared with group 2 at 1 and 3 months after SCI. Non-voiding contractions (NVCs) were inhibited in group 1 compared with group 2. Collagen fibers were significantly increased and elastic fibers were significantly decreased (Po0.05) in group 2 when compared with group 1. Conclusion: Early low-frequency pudendal nerve stimulation can inhibit detrusor overactivity (DO), increase bladder capacity and delay the progression of bladder fibrosis.
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