Chronic Electrical Stimulation of the Paraplegic Bladder

Grimes, John H.; Nashold, Blaine S.; Currie, D. Patrick

doi:10.1016/s0022-5347(17)60397-5

Cited by 17 publications

(4 citation statements)

References 15 publications

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“…Clinical experimentation using this stimulator was begun in 1970 and has been used in 10 patients Grimes, Nashold and Currie, 1973). The procedure was approved by the medical committee on human experimentation and the experimental nature was discussed with the patient and his family.…”

Section: Methodsmentioning

confidence: 99%

“…The chronic depth electrodes now used consist of 2 platinum-iridium wires 2.5 mm in length and 2.5 mm apart, mounted on a Silastic clip.The electric parameters found most helpful include a biphasic square wave at 15-20 cycles per second. The stimulus is applied for 20-30 seconds using lo-15 volts.Clinical experimentation using this stimulator was begun in 1970 and has been used in 10 patients Grimes, Nashold and Currie, 1973). The procedure was approved by the medical committee on human experimentation and the experimental nature was discussed with the patient and his family.…”

mentioning

confidence: 99%

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Clinical Application of Electronic Bladder Stimulation in Paraplegics

Grimes

Nashold

1974

British Journal of Urology

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In the last 2 decades great progress has been made in the care of patients with neurogenic bladders. The development of antibacterial therapy for urinary tract infections, the recommendation of intermittent catheterisation in place of continual catheter drainage, and the judicial use of operative procedures to relieve obstruction or to divert the urine, have all reduced the urologic morbidity and mortality associated with this problem. There are still some patients, however, who continue to have recurrent urinary tract infections, who do not develop a satisfactory reflex bladder, and who do not respond satisfactorily to intermittent catheterisation.The initial report of stimulation of the spinal cord and pelvic nerves occurred over 100 years ago (Budge, 1864). In the intervening years a stimulus has been given to the pudendal, hypogastric and pelvic nerves as well as the bladder, in animal laboratories. Clinical experimentation was initiated by Dees in 1940 using an intrarectal probe, and intravesical catheter-electrodes (Katona, 1958) and electrodes implanted into the detrusor muscle have also been used. The failure rate in these early studies was high and prompted our interest in a more satisfactory means of achieving complete micturition. MaterialsOur initial laboratory efforts (Friedman, Nashold and Senechal, 1972) involved acute and chronic experiments on cats and dogs. Surface stimulation of the lumbar and sacral spinal cord elicited excellent bladder pressures, but without micturition. Highest bladder pressures were obtained at the S2 level. Stimulation above Sl induced activation of skeletal muscle with contraction of the perineal musculature and tonic-clonic movement in the lower extremities.Use of a depth electrode induced similar bladder pressures with voiding. Descending visceral motor pathways for the bladder lie in the medial portion of the lateral columns and it was felt that positioning the electrodes within the central grey matter induced their activation. Subsequent autopsy examination of adult human spinal cords yielded an average depth for the intermediolateral grey column in the sacral cord of 2.5 mm. The chronic depth electrodes now used consist of 2 platinum-iridium wires 2.5 mm in length and 2.5 mm apart, mounted on a Silastic clip.The electric parameters found most helpful include a biphasic square wave at 15-20 cycles per second. The stimulus is applied for 20-30 seconds using lo-15 volts.Clinical experimentation using this stimulator was begun in 1970 and has been used in 10 patients Grimes, Nashold and Currie, 1973). The procedure was approved by the medical committee on human experimentation and the experimental nature was discussed with the patient and his family. ProceduresCareful patient selection and evaluation should be conducted before consideration of implantation of a spinal cord stimulator. In this initial patient group, only paraplegics have been con-

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Clinical Application of Electronic Bladder Stimulation in Paraplegics

Grimes

Nashold

1974

British Journal of Urology

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“…Attempts to elicit detrusor contraction by electrodes implanted at the bladder wall, pelvic nerve, sacral nerve root, and spinal cord as a treatment for voiding dysfunction have been described in the literature [9][10][11]. These attempts produced artificial micturition patterns with high intravesical pressures and involuntary movements of the lower limbs.…”

Section: Interventions At the Nervous Systemmentioning

confidence: 99%

Impaired detrusor contractility: Anything new?

Madjar¹,

Appell²

2002

Curr Urol Rep

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Impaired detrusor contractility (IDC) is a poorly defined entity that represents a treatment challenge for the urologist. The etiology of IDC is variable and may include neurologic disorders, inflammatory conditions, and pharmacologic and psychogenic causes. The gold standard for the treatment of IDC is clean intermittent catheterization (CIC). Although well-established as efficacious and safe, CIC may be conceived as a major burden on a patient's quality of life and has been associated with urinary tract infections and urethral and/or bladder injury. Alternative treatment modalities for IDC can be divided into interventions at the nervous system supplying the bladder, the bladder itself, or the bladder outlet. We review and discuss novel and creative treatment options for patients with IDC that have been developed or tested over the past decade.

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“…Die direkte Stimulation des Rückenmarks war eine weitere Methode für die Erregung der zur Blase ziehenden Nerven (28,38,39,54). Die Stimulationselektroden wurden hierzu in die intermedio-laterale graue Rückenmarksubstanz in Höhe des Conus medullaris eingebracht.…”

Section: Geschichte Der Blasenstimulation Bei Querschnittslähmungunclassified

Funktionelle Wiederherstellung der Blasenfunktion bei spastischer Querschnittslähmung mittels Elektrostimulation und sakraler Deafferentation

Wipfler¹,

Kp²

1995

Aktuel Urol

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ZusammenfassungBei querschnittsgelähmten Patienten mit einer Schädigung oberhalb des zweiten sakralen Rücken-markssegmentes S2, entsprechend der Wirbelsäulen-höhe Thl2/Ll, bildet sich nach der initialen Phase des spinalen Schocks nach mehreren Monaten eine spastische Blasenlähmung aus. Durch das Fehlen hemmender Einflüsse übergeordneter Neurone auf das sakrale Miktionszentrum kommt es zu einer pathologisch gesteigerten Aktivität innerhalb der Reflexbogen auf Rücken-marksebene. Dies führt zu einer Hyperreflexie von Blase und Schließmuskel mit ungehemmten Kontraktionen des Blasenmuskels (Detrusor) bei gleichzeitiger Spastik der Muskulatur des Beckenbodens. Trotz urologischer Intervention hat dies häufig eine nicht steuerbare Inkontinenz (Reflexinkontinenz) mit Schädigungen am oberen Harntrakt zur Folge, die bis zu einer chronischen Niereninsuffizienz führen können. Bei diesen Patienten ist daher die Wiederherstellung einer annähernd physiologischen Blasenfunktion nicht nur für die Lebensqualität, sondern vor allem auch im Hinblick auf die Gesamtprognose und Lebenserwartung von vordergründiger Bedeutung. Die Wiedererlangung der Blasenfunktion kann seit mehreren Jahren durch Kombination einer kompletten sakralen Deafferentation mit der Implantation eines sogenannten ,Blasenstimulators' zur Elektrostimulation sakraler Vorderwurzeln realisiert werden und ist, wenn auch bisher nur an wenigen, dafür spezialisierten Zentren, zu einem festen Bestandteil der klinisch-urologischen Behandlung querschnittsgelähmter Patienten geworden. Functional Restoration of Bladder Function in Spinal Cord Injury Through Electrical Stimulation and Sacral DeafferentationIn patients suffering from spinal cord injury above the second spinal cord segment S2, corresponding to a Thl2/Ll skeletal spine level, a spastic neuropathic bladder develops a few months after the injury following the initial stage of spinal shock. The condition is characterized by pathologically increased activity within the reflex arches at the level of the spinal cord due to abolished inhibitory influences of upper neurons on the sacral micturition center. This leads to hyperreflexy of both bladder and sphincter with uninhibited contractions of the bladder muscle (detrusor) and simultaneous spasticity of the pelvic floor musculature. Even after Intervention by the urologist, a common sequel is incontinence that cannot be controlled by the patient (reflex incontinence) with damage to the upper urinary tract that can lead to chronic renal insufficiency. Therefore, the restoration of an almost physiological bladder function is of major importance in these patients, not only for their quality of life, but mainly in terms of overall prognosis and life expectancy. In the past several years, restoration of bladder function has been accomplished through a combination of complete sacral deafferentation and the implantation of a so-called bladder stimulator for electrostimulation of sacral anterior roots. Although only at few, specialized centers, this has become an established trea...

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Chronic Electrical Stimulation of the Paraplegic Bladder

Cited by 17 publications

References 15 publications

Clinical Application of Electronic Bladder Stimulation in Paraplegics

Clinical Application of Electronic Bladder Stimulation in Paraplegics

Impaired detrusor contractility: Anything new?

Funktionelle Wiederherstellung der Blasenfunktion bei spastischer Querschnittslähmung mittels Elektrostimulation und sakraler Deafferentation

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