Neuromodulation by surface electrical stimulation of peripheral nerves for reduction of detrusor overactivity in patients with spinal cord injury: A pilot study

Abstract

Objectives: To demonstrate reduction in detrusor overactivity using surface electrical stimulation of posterior tibial nerve (PTN) or dorsal penile nerve (DPN) in patients with spinal cord injury (SCI). Design: Patients with SCI with symptoms of urinary urgency/leaks, with cystometrogram (CMG) proven detrusor overactivity were recruited in this study. Ten persons with observable F-wave from tibial nerve were included in the PTN group. Five persons who had F-wave absent but preserved bulbocavernosus reflex were included in the DPN group. Stimulation was given at 20 Hz, 10-40 mA for 20 minutes/session/day for 14 consecutive days. Detrusor overactivity was recorded using CMG on days 1 and 15. Settings: Rehabilitation Institute, Department of Physical Medicine and Rehabilitation, Christian Medical College and Hospital, Vellore, TN, India. Participants: Patients with SCI. Interventions: Surface stimulation of peripheral nerves for reduction of detrusor overactivity. Outcome measures: Qualitative analysis using voiding diary data and quantitative analysis using CMG data comparing pre-and post-intervention. Results: P value obtained from voiding chart was 0.021 for PTN and 0.062 for DPN. P value obtained from CMG data was not significant in both groups. In one subject, treatment was extended to 4 weeks and further improvement in voiding diary was seen. Conclusions: In this pilot study of 15 patients, voiding chart data showed statistically significant improvement following PTN stimulation and trend of improvement following DPN stimulation. However, the CMG data were not statistically significant in this sample population. Further studies with larger, appropriately powered sample size would be helpful to demonstrate the associations of symptoms with CMG data.

Transcutaneous Electrical Stimulation for Neurogenic Bladder Dysfunction Following Spinal Cord Injury: Meta-Analysis of Randomized Controlled Trials

“…A recent article reported that DGN stimulation acutely suppressed bladder contractions and increased bladder capacity in people with SCI, whereas tibial nerve stimulation, sacral nerve stimulation, and spinal stimulation did not improve (33). Ojha et al showed statistically significant improvement following TTNS and a trend of improvement following DGN stimulation (34). The DGN is a terminal branch of the pudendal nerve, a mixed sensory-motor nerve originating from S2 to S4.…”

Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury

“…60 Electrical stimulation of the posterior tibial nerve or the sensory branch of the pudendal nerve is expected to improve urinary incontinence (LoE 3, GoR pending (not yet approved)). 61,62…”

Effects of Genital Nerve Stimulation Amplitude on Bladder Capacity in Spinal Cord Injured Subjects

“…For example, sacral nerve stimulation (SNS) [4] therapy and transcutaneous tibial nerve stimulation (TTNS) [5–7] therapy have been used to treat subjects with SCI and NDO. Although both TTNS and SNS therapies have been reported to significantly improve urinary continence by increasing bladder capacity in subjects with incomplete SCI [5–7], a few recent studies report that TTNS and SNS did not produce a satisfactory outcome in related clinic trials [8, 9]. Moreover, these two neuromodulation approaches are not effective for increasing bladder capacity in individuals with complete SCI; it is still unclear why both approaches failed to improve urinary continence in these individuals.…”