Outcomes of electrical stimulation of the neurogenic bladder: Results of a two-year follow-up study

Abstract

INTRODUCTION:The complications of neurogenic dysfunction of the urinary bladder still constitute an important cause of death among spinal cord injury patients. AIM OF STUDY: The aim of this study was to assess transcutaneous electrical stimulation of the urinary bladder as a treatment for micturition disorders in patients after spinal cord injury (SCI) over 2 years of follow-up. MATERIAL AND METHODS:The study involved 28 patients (22 men and 6 women) with neurogenic bladder dysfunction following a spinal cord injury. The patients were 16 to 68 years old and 2 to 26 months since their spinal cord injury. The therapeutic programme involved 30 sessions of electrical stimulation of the urinary bladder, five sessions per week. The outcomes of electrical stimulation were assessed by comparing the results of urodynamic examinations performed before treatment, immediately on completion of the treatment and at 24 months post-treatment. RESULTS: Transcutaneous electrical stimulation of the urinary bladder produced a significant increase in bladder capacity (p = 0.001), which was higher by a mean of 117.7 ml immediately on completion of the treatment and a mean of 101.6 ml (p = 0.018) two years after the treatment. The amount of post-void residual urine in the bladder decreased by a mean of 81.9 ml (p = 0.007) immediately after completion of the treatment and a mean of 76.9 ml (p = 0.011) two years after the treatment. Opening pressure was lower by a mean of 3.1 cm H 2 O (p > 0.05) immediately on completion of the electrical stimulation treatment. Intravesical pressure at maximum flow decreased in 19 patients (68%) by a mean of 11.6 cm H 2 O (p > 0.05). At the late follow-up assessment, opening pressure was lower in 17 patients (68%) by a mean of 6.7 cm H 2 O. Two patients demonstrated the micturition phase, which had been absent at baseline and immediately after completion of the treatment. Opening pressure in the entire group was lower compared to baseline by 2.9 cm H 2 O (p > 0.05). Also in the late follow-up assessment, intravesical pressure at maximum flow was reduced in 21 patients (79%) by a mean of 9.6 cm H 2 O (p > 0.05).The maximum voiding velocity increased by a mean of 3.8 ml/s (p = 0.008) immediately after treatment completion and by a mean of 3.6 ml/s (p < 0.001) at two years post-treatment. CONCLUSIONS: Transcutaneous electrical stimulation of the neurogenic bladder in patients following spinal cord injury improves lower urinary tract function. Improved urinary tract function is seen two years following completion of the electrical stimulation treatment.

Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12‐months results

“…To our knowledge few studies have been performed to determine the effects of PTNS on NDO in patients with MS. Acute urodynamic effects of PTNS in NOAB were studied with different neurological disorders including MS, spinal cord injury, and PD . In our previous studies we reported the effects of PTNS with acute urodynamic parameters on NDO in MS and PD patients and we found an increase of first involuntary detrusor contraction volume and of cystometric capacity with NOAB patients .…”

Implantable Direct Current Neural Modulation: Theory, Feasibility, and Efficacy

“…Typically, patients suffer from an inability to fully void the bladder, which can lead to severe complications including kidney failure (Krause et al, 2004; Biering-Sørensen et al, 2008). Non-invasive DC modulation of the spinal cord has had some success restoring micturition function in humans (Flamm et al, 1977; Radziszewski, 2013; Stewart et al, 2016; Zhu et al, 2016). The mechanism of action is thought to be subthreshold modulation of spinal circuits rather than the result of DC-evoked spike trains (Kerns et al, 1996; Ahmed and Wieraszko, 2012; Ahmed, 2013, 2017).…”

“…DC delivery closer to the target tissue could improve effect thresholds and reduce current spread to non-target tissues. Additionally, non-invasive DC still must contend with toxic electrochemical reactions generated at the metal-electrolyte interface, and is typically only delivered therapeutically for relatively short periods (Radziszewski, 2013). An implantable system capable of delivering chronic DC could provide tonic active therapy for cases where short-duration therapy is not efficacious.…”

Cortical and Subcortical Effects of Transcutaneous Spinal Cord Stimulation in Humans with Tetraplegia

“…TESS has shown improvements in sensory and motor function when it is applied alone or in combination with other therapies (Hofstoetter et al, 2013;Gerasimenko et al, 2015;Gad et al, 2017Gad et al, , 2018Inanici et al, 2018). Improved cardiovascular (Phillips et al, 2018) and bladder (Horst et al, 2013;Radziszewski, 2013) functions and reduced spasticity (Hofstoetter et al, 2014(Hofstoetter et al, , 2020 have also been observed. While it is clear that single TESS pulses generate spinally mediated responses activating spinal networks that project transsynaptically to motoneurons (Milosevic et al, 2019), the effects of repeated use of TESS on CNS pathways remain unknown.…”