Transcutaneous electrical stimulation of thigh muscles in the treatment of detrusor overactivity

Abstract

Objective To investigate the clinical effects on detrusor overactivity of a new method of transcutaneous reciprocal electrical stimulation of the thigh muscles. Patients and methods Nineteen patients with detrusor overactivity, comprising 14 with detrusor hyper‐reflexia (DH) and five with idiopathic detrusor instability (IDI), were studied. Electrical stimulation was applied alternately to the quadriceps and hamstring muscles of one or both legs through surface electrodes for 20 min. The treatment was given once a day for 14 days and then the patients were evaluated urodynamically. Results All 19 patients tolerated the therapy well and none reported any adverse effects. The mean maximum cystometric capacity increased significantly (P<0.05) after treatment. In 11 of the 19 patients, the maximum cystometric capacity was increased by >50% of the pretreatment value; this occurred in eight of 14 of those with DH and in three of five of those with IDI. In six of the 11 who responded in this way, there was a clinical improvement in their urinary incontinence and frequency for several weeks to 3 months after the period of therapy. A second 14‐day treatment was also effective in all four patients who underwent a repeat trial. Conclusion This method of transcutaneous electrical stimulation can inhibit DH as well as IDI with no adverse effects. The suppressive effect on detrusor overactivity may persist for several months and repeat trials appear to be effective. Thus, we believe that this new stimulation technique should be tried as an alternative to other types of electrical stimulation and augmentation cystoplasty.

A longitudinal study over 5 to 10 years of clinical outcomes in women with idiopathic detrusor overactivity

“…If this was not helpful, then other treatments such as transcutaneous electrical nerve stimulation or electroacupuncture (Stoller Afferent Nerve Stimulator) were considered. 8,9 At each follow up visit, it was routine practice to ask women by what percentage their symptoms had improved or worsened. The woman was asked to consider that at their first visit symptoms were defined as '100% bad'.…”

“…Overall, as shown in Table 3, 35% of women responded to treatment, representing a decrease of 14% in the treatment response from that determined at the last clinic review. The median duration of clinical disease for those participating in the study was 13 years (9-18), with responders reporting symptoms for significantly less time (10 years [7][8][9][10][11][12][13][14][15][16] versus 15 years [10-18] MW-U, P = 0.049). The median number of therapies received by the group was 3 (2-4), with 20% having had only one treatment and 25% having had more than four treatments.…”

Efficacy of transcutaneous functional electrical stimulation on urinary incontinence in myelomeningocele: results of a pilot study

“…This kind of treatment can cause hypertrophy of muscle fibers, possibly by the recruitment of motor units with faster conduction and alter the expression of myosin isoforms, favoring a conversion to type l muscle fibers (4). An effect of FES at the peripheral level can be modulation of neurotransmitters such as cholinergic and β-adrenergic system (16). In a study by Ishigooka et al, reduction in norepinephrine content of the rabbit urinary bladder by a combination of yohimbine and electrical stimulation of pelvic floor musculature has been reported.…”

Control of urinary bladder function with devices: successes and failures

“…Jones, 1987) perhaps indicating a suppression of detrusor hyperreflexia. A more recent study examining urodynamic changes in response to thigh muscle stimulation showed that 8 of 14 patients, including a single subject with spinal cord injury with neurogenic detrusor overactivity, increased their bladder volumes by >50% (Okada et al, 1998). However, no methods of identifying those patients likely to respond positively to treatment exist.…”

“…The effects of electrical stimulation of the thigh muscles on the bladder may be mediated by limb afferents known to inhibit bladder contractions to prevent leakage during physical activity (Fall and Lindstrom, 1991), although other mechanisms have been proposed (Okada et al, 1998). Carry-over, observed with thigh stimulation, has also been observed with other electrical stimulation techniques (Fall and Lindstrom, 1991), and may be at least partially explained by mechanisms such as those proposed by Vodovnik (1981).…”