Detrusor inhibition induced by stimulation of pudendal nerve afferents

Vodušek, David B.; Light, J. Keith; Libby, James M.

doi:10.1002/nau.1930050404

Cited by 237 publications

(116 citation statements)

References 10 publications

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“…The rise in bladder volume during the three initial control ®lls in our six patients was signi®cant ± this e ect has been noted before. 24,25 The persisting (but diminishing) e ect following neuromodulation in the ®nal control ®lls has also been found before, 7,8 and was probably due to two main factors. Firstly, an initial mechanical distension is likely to diminish a erent discharge from the bladder at a given volume during subsequent ®lls; such an e ect has been shown directly in cats.…”

Section: Discussionmentioning

confidence: 55%

The acute effects of continuous and conditional neuromodulation on the bladder in spinal cord injury

et al. 2001

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Study design: Laboratory investigation using serial slow-®ll cystometrograms. Objectives: To examine the acute e ects of di erent modes of dorsal penile nerve stimulation on detrusor hyperre¯exia, bladder capacity and bladder compliance in spinal cord injury (SCI). Setting: Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. Methods: Fourteen SCI patients were examined. Microtip transducer catheters enabled continuous measurement of anal sphincter, urethral sphincter and intravesical pressures. Control cystometrograms were followed by stimulation of the dorsal penile nerve at 15 Hz, 200 ms pulse width and amplitude equal to twice that which produced a pudendo-anal re¯ex. Stimulation was either continuous or in bursts of one minute triggered by a rise in detrusor pressure of 10 cm water (conditional). Further control cystometrograms were then performed to examine the residual e ects of stimulation. Results: Bladder capacity increased signi®cantly during three initial control ®lls. Continuous stimulation (n=6) signi®cantly increased bladder capacity by a mean of 110% (+Standard Deviation 85%) or 173 ml (+146 ml), and bladder compliance by a mean of 53% (+31%). Conditional stimulation in a di erent group of patients (n=6) signi®cantly increased bladder capacity, by 144% (+127%) or 230 ml (+143 ml). In the conditional neuromodulation experiments, the gap between suppressed contractions fell reliably as bladder volume increased, and the time from start of stimulation to peak of intravesical pressure and 50% decline in intravesical pressure rise was 2.8 s (+0.9 s) and 7.6 s (+1.0s) respectively. The two methods of stimulation were compared in six patients; in four out of six conditional neuromodulation resulted in a higher mean bladder capacity than continuous, but the di erence was not signi®cant. Conclusions: Both conditional and continuous stimulation signi®cantly increase bladder capacity. The conditional mode is probably at least as e ective as the continuous, suggesting that it could be used in an implanted device for bladder suppression. Spinal Cord (2001) 39, 420 ± 428

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Section: Discussionmentioning

confidence: 55%

The acute effects of continuous and conditional neuromodulation on the bladder in spinal cord injury

et al. 2001

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“…Excitation of the bladder was evoked at stimulus strengths of 0.5-4 times the threshold of the pudendal-EUS reflex, whereas previous reports of inhibition in rat used stimuli (0.8 mA) that were sixteen times our measured threshold . Similarly, large amplitude stimulation of pudendal afferents produced bladder inhibition in both cat (Lindstrom et al 1983, Mazieres et al 1998, Tai et al 2006 and human (Vodusek et al 1986, Ohlsson et al 1989, although both frequency and stimulus train duration also play an important role in determining the response polarity in cat (Boggs et al 2006).…”

Section: Discussionmentioning

confidence: 98%

Improved bladder emptying in urinary retention by electrical stimulation of pudendal afferents

et al. 2008

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Urinary retention is the inability to empty the bladder completely, and may result from bladder hypocontractility, increases in outlet resistance, or both. Chronic urinary retention can lead to several urological complications and is often refractory to pharmacologic, behavioral, and surgical treatments. We sought to determine whether electrical stimulation of sensory fibers in the pudendal nerve could engage an augmenting reflex and thereby improve bladder emptying in an animal model of urinary retention. We measured the efficiency of bladder emptying with and without concomitant electrical stimulation of pudendal nerve afferents in urethane anesthetized rats. Voiding efficiency (VE=voided volume/initial volume) was reduced from 72±7% to 29±7% following unilateral transection of the sensory branch of the pudendal nerve (UST) and from 70±5% to 18±4% following bilateral transection (BST). Unilateral electrical stimulation of the proximal transected sensory pudendal nerve during distention-evoked voiding contractions significantly improved VE. Low intensity stimulation at frequencies of 1-50 Hz increased VE to 40-51% following UST and to 39-49% following BST, while high intensity stimulation was ineffective at increasing VE. The increase in VE was mediated by increases in the duration of distention-evoked voiding bladder contractions, rather than increases in contraction amplitude. These results are consistent with an essential role for pudendal sensory feedback in efficient bladder emptying, and raise the possibility that electrical activation of pudendal nerve afferents may provide a new approach to restore efficient bladder emptying in persons with urinary retention.

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“…Low frequency activation (5 ~ 20 Hz) of the dorsal genital nerve results in robust inhibition of detrusor activity, significant increases in cystometric capacity in persons with SCI (Dalmose, et al, 2003, Fjorback, et al, 2006, Hansen, et al, 2005, Kirkham, et al, 2001, Vodusek, et al, 1986, Wheeler, et al, 1994, and is a potential treatment for urinary incontinence (i.e., urine storage). The same continence promoting inhibition of the bladder is evoked by low frequency stimulation (3 ~ 15 Hz) of the pudendal nerve trunk , Lindstrom, et al, 1983, Sundin, et al, 1974, Walter, et al, 1993, or selective dorsal genital nerve (Woock, et al, submitted) in both spinal intact and chronically transected cats, and this enabled identification of potential underlying mechanisms (Craggs and McFarlane, 1999).…”

Section: Introductionmentioning

confidence: 99%

Bladder activation by selective stimulation of pudendal nerve afferents in the cat

Yoo

Woock

Grill

2008

Experimental Neurology

114

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Bladder contractions evoked by pudendal nerve stimulation in both spinal intact and spinal transected cats support the possibility of restoring urinary function in persons with chronic spinal cord injury (SCI). However, electrically evoked bladder responses in persons with SCI were limited to transient contractions at relatively low pressures. This prompted the present study, which presents a detailed quantification of the responses evoked by selective stimulation of individual branches of the pudendal nerve at different stimulation frequencies. In spinal intact cats anesthetized with α-chloralose, selective frequency dependent electrical activation of the sensory (2 Hz ≤ f ≤ 50 Hz), cranial sensory (f ≤ 5 Hz), dorsal genital (f ≥ 20 Hz) and rectal perineal (f ≤ 10 Hz) branches of the pudendal nerve evoked sustained bladder contractions dependent on the stimulation frequency. Contractions evoked by selective electrical stimulation resulted in significant increases in voiding efficiency compared to bladder emptying by distension evoked contractions (p ANOVA < 0.05). Acute spinal transection abolished reflex bladder contractions evoked by low frequency stimulation of the cranial sensory or rectal perineal branches, whereas contractions evoked by high frequency stimulation of the dorsal genital branch remained intact. This study presents evidence for two distinct micturition pathways (spino-bulbo-spinal vs. spinal reflexes) activated by selective afferent pudendal nerve stimulation, the latter of which may be applied to restore bladder function in persons with SCI. Keywords electrical stimulation; cranial sensory nerve; deep perineal branch; lower urinary tract physiology; external urethral sphincter; spinal cord injury; pudendo-pudendal reflex; spinal-bulbo-spinal; prostatic urethra; dorsal nerve of penis

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Detrusor inhibition induced by stimulation of pudendal nerve afferents

Cited by 237 publications

References 10 publications

The acute effects of continuous and conditional neuromodulation on the bladder in spinal cord injury

The acute effects of continuous and conditional neuromodulation on the bladder in spinal cord injury

Improved bladder emptying in urinary retention by electrical stimulation of pudendal afferents

Bladder activation by selective stimulation of pudendal nerve afferents in the cat

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