Frequency Dependent Tibial Neuromodulation of Bladder Underactivity and Overactivity in Cats

Theisen, Katherine M.; Browning, Jeffery; Li, Xing; Li, Shun; Shen, Bing; Wang, Jicheng; Roppolo, James R.; Groat, William C. de; Tai, Changfeng

doi:10.1111/ner.12792

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…Syndrome) can be treated with sacral neuromodulation and therefore must have a neurologic dysfunction that contributes to their voiding problem. 3 The present experiments confirm and extend previous reports [10][11][12][13] that electrical stimulation of somatic afferent inputs to the spinal cord can elicit opposing changes in bladder function presumably by activating either inhibitory or excitatory mechanisms in the central nervous system. It is known that these opposing effects are not only produced by different afferent nerves but also by different frequencies of stimulation.…”

supporting

confidence: 88%

“…It is known that these opposing effects are not only produced by different afferent nerves but also by different frequencies of stimulation. For example, the 5 Hz stimulation of the tibial nerve which was used in the present study produces prolonged inhibition of reflex bladder activity that can be transiently reversed by subsequent 1 Hz stimulation of the tibial nerve, 12 as well as by 1 Hz stimulation of the saphenous 13 or the peroneal nerve. 11 These studies were all performed under isovolumetric bladder conditions by measuring stimulationevoked changes in the storage function of the bladder, that is, changes in bladder capacity.…”

mentioning

confidence: 78%

“…The failure of transcutaneous SPNSc to reverse NOUR (Figure 4) could be due to: (a) the inability of noninvasive SPNSc to activate the nerve as completely as the invasive SPNSc; (b) the weaker noninvasive SPNSc lost its effect on voiding due to its longer application time than SPNSv and possible stimulation fatigue. It is worth noting that 1-Hz TNS is also excitatory to the bladder 12 and it may also reverse NOUR. However, the tibial nerve at the ankle is much deeper than the superficial peroneal nerve at the dorsal surface of the foot.…”

mentioning

confidence: 99%

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Superficial peroneal neuromodulation of nonobstructive urinary retention in cats

Zhao

Chen

Guo

et al. 2020

Neurourology and Urodynamics

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Aims To determine if superficial peroneal nerve stimulation (SPNS) can improve nonobstructive urinary retention (NOUR). Methods In α‐chloralose anesthetized cats, NOUR was induced by repetitive application (4‐16 times) of 30‐minute tibial nerve stimulation (TNS: 5 Hz frequency, 0.2 ms pulse width) at 4 to 6 times threshold intensity (T) for inducing toe twitches. SPNS (1 Hz, 0.2 ms) at 2 to 4 times threshold intensity (T) for inducing posterior thigh muscle contractions was applied either continuously (SPNSc) during a cystometrogram (CMG) or during voiding (SPNSv) by a surgically implanted cuff electrode or by skin surface electrodes to determine if the stimulation reduced NOUR induced by prolonged TNS. Results During control CMGs, efficient (86.4% ± 5.5%) voiding occurred with a postvoid residual (PVR) volume equal to 14.9% ± 6.2% of control bladder capacity. NOUR elicited by prolonged TNS significantly (P < .05) increased bladder capacity to 168.6% ± 15.5% of control, reduced voiding efficiency to 30.4% ± 4.8%, and increased PVR to 109% ± 9.2% of control. Using the implanted cuff electrode, SPNSc and SPNSv significantly (P < .05) increased voiding efficiency to 66.7% ± 7.4% and 65.0% ± 5.9%, respectively, and reduced PVR to 52.2% ± 11.4% and 64.3% ± 11.6%, respectively. SPNSc but not SPNSv significantly (P < .05) reduced bladder capacity to 133.4% ± 15% of control. Transcutaneous SPNSv but not SPNSc also significantly (P < .05) reversed the TNS‐induced NOUR responses. Conclusions This study shows that SPNS is effective in reversing NOUR induced by prolonged TNS. Transcutaneous SPNS provides the opportunity to develop a noninvasive neuromodulation therapy for NOUR to treat more patients than current sacral neuromodulation therapy.

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confidence: 88%

mentioning

confidence: 78%

mentioning

confidence: 99%

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Superficial peroneal neuromodulation of nonobstructive urinary retention in cats

Zhao

Chen

Guo

et al. 2020

Neurourology and Urodynamics

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“…The opposite type of persistent neuromodulation of reflex bladder activity was observed following prolonged (30 min) electrical stimulation (5 Hz) of afferent axons in the tibial nerve of the cat (29). The stimulation produced a marked increase in bladder capacity lasting more than 1 h but could be transiently reversed by low-frequency electrical stimulation (1 Hz) of the same nerve (30) or another nerve (peroneal) in the hindlimb (1-3 Hz) (33). A persistent reduction in overactive bladder symptoms that may last for weeks occurs clinically following a 30 min/wk, 12-wk course of percutaneous tibial nerve stimulation (23).…”

Section: Discussionmentioning

confidence: 94%

“…For example, electrical stimulation of pudendal nerve afferents (20 -30 Hz) excites the bladder, whereas stim- ulation at lower frequencies inhibits bladder activity (28). Electrical stimulation of the tibial nerve also exhibits a bimodal frequency dependence in which a low frequency (1 Hz) excites the bladder and a higher frequency (5-20 Hz) inhibits the bladder (30). Stimulation at 1 Hz of other somatic limb afferents (saphenous and peroneal nerves) also excites the bladder (17,33).…”

Section: Discussionmentioning

confidence: 99%

Sympathetic afferents in the hypogastric nerve facilitate nociceptive bladder activity in cats

Zhang

Yecies

et al. 2019

American Journal of Physiology-Renal Physiology

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This study in α-chloralose-anesthetized cats revealed a role of hypogastric nerve afferent axons in nociceptive bladder activity induced by bladder irritation using 0.25% acetic acid (AA). In cats with intact hypogastric and pelvic nerves, AA irritation significantly ( P < 0.05) reduced bladder capacity to 45.0 ± 5.7% of the control capacity measured during a saline cystometrogram (CMG). In cats with the hypogastric nerves transected bilaterally, AA irritation also significantly ( P < 0.05) reduced bladder capacity, but the change was significantly smaller (capacity reduced to 71.5 ± 10.6% of saline control, P < 0.05) than that in cats with an intact hypogastric nerve. However, application of hypogastric nerve stimulation (HGNS: 20 Hz, 0.2 ms pulse width) to the central end of the transected nerves at an intensity (16 V) strong enough to activate C-fiber afferent axons facilitated the effect of AA irritation and further ( P < 0.05) reduced bladder capacity to 48.4 ± 7.4% of the saline control. This facilitation by HGNS was effective only at selected frequencies (1, 20, and 30 Hz) when the stimulation intensity was above the threshold for activating C-fibers. Tramadol (an analgesic agent) at 3 mg/kg iv completely blocked the nociceptive bladder activity and eliminated the facilitation by HGNS. HGNS did not alter non-nociceptive bladder activity induced by saline distention of the bladder. These results indicate that sympathetic afferents in the hypogastric nerve play an important role in the facilitation of the nociceptive bladder activity induced by bladder irritation that activates the silent C-fibers in the pelvic nerve.

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Efficacy of a novel wearable transcutaneous tibial nerve stimulation device on bladder reflex compared to implantable tibial nerve stimulation in cats

Zhou

Zhao

et al. 2022

Int Urol Nephrol

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Objective To determine the efficacy of novel wearable transcutaneous tibial nerve stimulation (TTNS) device on bladder reflex in cats compared to implantable tibial nerve stimulation (ITNS). Materials and methods Two self-adhesive electrodes of the TTNS device were placed at the left leg, and ITNS was applied to stimulate the tibial nerve of the right leg, respectively. The intensity threshold (T) was defined as inducing observable toe movement. Multiple cystometrograms (CMGs) with normal saline (NS) infusion were performed to determine the inhibitory effects of TTNS and ITNS on the micturition reflex. Results TTNS at 4 times T (4 T), 6 times T (6 T), and the maximum output current intensity 24 mA significantly increased the bladder capacity (BC) compared to the control level (8.70 ± 2.46 ml) (all p < 0.05); however, there was no statistical significance among the three intensities. At the same time, ITNS at 2 times T (2 T), 4 T, 6 T, and the current intension 24 mA could significantly increase the BC compared to the control level (all p < 0.05). Likewise, no significant difference was observed among the four intensities ( p > 0.05). The T values of TTNS were higher than those of ITNS ( p = 0.02). The inhibitory effects of TTNS and ITNS revealed no significant difference at their respective 2 T, 4 T, 6 T, and 24 mA. Neither TTNS nor ITNS changed the contraction duration and amplitude (all p > 0.05). Conclusions TTNS was effective in increasing BC. The non-invasive neuromodulation technique could achieve a similar effect as ITNS.

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Frequency Dependent Tibial Neuromodulation of Bladder Underactivity and Overactivity in Cats

Abstract: This study indicates that TNS at different frequencies might be used to treat bladder underactivity and overactivity.

Cited by 10 publications

References 25 publications

Superficial peroneal neuromodulation of nonobstructive urinary retention in cats

Superficial peroneal neuromodulation of nonobstructive urinary retention in cats

Sympathetic afferents in the hypogastric nerve facilitate nociceptive bladder activity in cats

Efficacy of a novel wearable transcutaneous tibial nerve stimulation device on bladder reflex compared to implantable tibial nerve stimulation in cats

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