Stimulation of the sensory pudendal nerve increases bladder capacity in the rat

Abstract

Pudendal nerve stimulation is a promising treatment approach for lower urinary tract dysfunction, including symptoms of overactive bladder. Despite some promising clinical studies, there remain many unknowns as to how best to stimulate the pudendal nerve to maximize therapeutic efficacy. We quantified changes in bladder capacity and voiding efficiency during single-fill cystometry in response to electrical stimulation of the sensory branch of the pudendal nerve in urethane-anesthetized female Wistar rats. Increases in bladder capacity were dependent on both stimulation amplitude and rate. Stimulation that produced increases in bladder capacity also led to reductions in voiding efficiency. Also, there was a stimulation carryover effect, and increases in bladder capacity persisted during several nonstimulated trials following stimulated trials. Intravesically administered PGE reduced bladder capacity, producing a model of overactive bladder (OAB), and sensory pudendal nerve stimulation again increased bladder capacity but also reduced voiding efficiency. This study serves as a basis for future studies that seek to maximize the therapeutic efficacy of sensory pudendal nerve stimulation for the symptoms of OAB.

Sensory pudendal nerve stimulation increases bladder capacity through sympathetic mechanisms in cyclophosphamide‐induced cystitis rats

“…The sensory branch of the pudendal nerve contains nerve fibers that innervate the urethra, genitalia, and perigenital skin and stimulation can generate bladder inhibition 7 . The sensory pudendal nerve was accessed using a posterior approach with the animal in a prone position as described previously 11 .…”

“…An alternative to sacral neuromodulation that has not yet been explored for IC/BPS is sensory pudendal nerve stimulation. The pudendal nerve is a distal branch of S2–4 and pudendal nerve stimulation inhibits the micturition reflex and increase bladder capacity in animals 6,7 and humans 8 . Patients with voiding dysfunction and pudendal nerve stimulation demonstrated greater improvement in pelvic pain, urinary frequency, and urgency when compared to sacral neuromodulation 8 .…”

Designing and Implementing an Implantable Wireless Micromanometer System for Real-Time Bladder Pressure Monitoring: A Preliminary Study

“…Neuromodulatory techniques are commonly proposed to effectively control the storage and evacuation of urine in urological treatments of voiding dysfunction, by applying electrical stimulation to regulate the reflex activity of the bladder [ 26 , 27 , 28 , 29 ]. Many studies demonstrated that the modulation of the pudendal nerve reflex can facilitate reflex bladder contractions and improve bladder capacity in animals and humans [ 30 , 31 , 32 , 33 ]. Therefore, pudendal nerve modulation could be an alternative for treating patients with various voiding dysfunctions.…”

New therapeutic directions to treat underactive bladder

“…These electric signals from bladder filling was then used to feedback to initiate pudendal nerve stimulation [ 56 ]. As discussed above, pudendal nerve stimulation can augment bladder emptying in a diabetic DUA rat model [ 49 ], but pudendal nerve stimulation at different parameters can also increase bladder storage capability [ 57 ]. The closed-loop feedback systems are designed with the neurogenic bladder in mind because, often, the neurogenic bladder has both storage and emptying problems.…”