Short-term effect of pudendal nerve electrical stimulation on detrusor hyperreflexia in spinal cord injury patients: importance of current strength

Prévinaire, J G; Soler, JM; Perrigot, M.; Boileau, G; Delahaye, H; Schumacker, P; Vanvelcenaher, J.; Vanhee, J. L.

doi:10.1038/sc.1996.17

Cited by 56 publications

(55 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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: Discussionsupporting

confidence: 53%

“…One group has speci®cally examined the in¯uence of current strength on bladder suppression, achieving their best results at twice the threshold and markedly reduced suppression when stimulating at a level equal to the threshold. 24 In the current study, the pudendo-urethral re¯ex had a lower threshold than the pudendo-anal re¯ex in a majority of patients, a point which should be borne in mind if using it to set the current level for neuromodulation.…”

Section: Conditional Neuromodulationmentioning

confidence: 58%

See 1 more Smart Citation

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

et al. 2001

View full text Add to dashboard Cite

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

show abstract

Section: Discussionsupporting

confidence: 53%

Section: Conditional Neuromodulationmentioning

confidence: 58%

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

et al. 2001

View full text Add to dashboard Cite

show abstract

“…The stimulation amplitude of the pulse train stimulation during bladder filling was not related to the threshold for the GAR, as the GAR could not effectively be evoked with pulse train stimulation in the majority of patients. Previnaire et al 12 showed that continuous stimulation (bipolar surface electrodes, rectangular pulse, 5 Hz, pulse width 500 ms) at twice the GAR threshold increases bladder capacity more than does a stimulus at one times the threshold (mean 24.2 mA, range 14.0-40.0 mA). Although our study did not assess capacity, and stimulation parameters were different, it also demonstrated the importance of amplitude on IDC suppression.…”

Section: Discussionmentioning

confidence: 99%

Minimal invasive electrode implantation for conditional stimulation of the dorsal genital nerve in neurogenic detrusor overactivity

2010

View full text Add to dashboard Cite

Study design: Experimental. Objectives: Electrical stimulation of the dorsal genital nerves (DGN) suppresses involuntary detrusor contractions (IDCs) in patients with neurogenic detrusor overactivity (DO). The feasibility of minimal invasive electrode implantation near the DGN and the effectiveness of conditional stimulation to suppress IDCs at different amplitudes in spinal cord injury (SCI) patients with DO were studied. Setting: Radboud University Nijmegen MC, The Netherlands. Methods: In eight healthy volunteers, a needle electrode was inserted from both a medial and lateralto-midline site at the level of the pubic bone. Electrode insertion was guided by the genito-anal reflex (GAR) evoked by electrical stimulation and by sensation to this stimulation. In eight SCI patients with DO, the bladder was repeatedly filled and emptied partially in between. Conditional stimulation using a needle electrode was applied when an IDC was observed at urodynamics. Different amplitudes were used during each filling. Control cystometry was carried out before electrode insertion and after stimulation. Results: The lateral implant approach was preferred, as it was easier to manoeuvre the needle along the pubic bone and fixate the needle. In SCI patients, the electrode was positioned successfully, and IDCs were suppressed (range 1-6 IDC suppressions) with conditional stimulation at maximum tolerable amplitude, except for one patient. Stimulation was less effective at lower amplitudes. Stimulation lowered the intensity of bladder sensations concomitant with IDC. Conclusion: The lateral-to-midline implant approach, in combination with GAR and sensation to stimulation, is feasible for electrode implantation near the DGN in SCI patients. Conditional stimulation effectively suppresses IDCs.

show abstract

“…This eect is observed in normal subjects, 1 idiopathic bladder instability, 2 and in the detrusor hyperre¯exia that is the likely consequence of spinal cord injury. 3 It can be termed neuromodulation, where`the in¯uence of activity in one neural pathway aects the pre-existing activity in another by synaptic interaction.…”

Section: Introductionmentioning

confidence: 99%

Neuromodulation through sacral nerve roots 2 to 4 with a Finetech-Brindley sacral posterior and anterior root stimulator

et al. 2002

View full text Add to dashboard Cite

Study design: Investigation of ®ve patients receiving an implant, using laboratory cystometry and self-catheterisation at home. Objectives: To use the established Finetech-Brindley sacral root stimulator to increase bladder capacity by neuromodulation, eliminating the need for posterior rhizotomy, as well as achieving bladder emptying by neurostimulation. Setting: Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. Methods: Five patients underwent implantation of a Finetech-Brindley stimulator without rhizotomy of the posterior roots. This was either a two channel extradural device (four cases) or a three channel intrathecal device (one case). In each patient, the implant was con®gured as a Sacral Posterior and Anterior Root Stimulator (SPARS). Postoperatively, repeated provocations using rapid instillation of 60 ml saline were used to determine the relative thresholds for neuromodulation using each channel. The eect of continuous neuromodulation was examined in the laboratory using slow ®ll cystometrograms, and conditional stimulation was also studied (neuromodulation for 1 min to suppress hyperre¯exic contractions as they occurred). In one patient, neuromodulation was applied continuously at home, and volumes at self catheterisation recorded in a diary. Results: Re¯ex erections were preserved in each patient. In three patients, detrusor hyperre¯exia persisted postoperatively and neuromodulation via the implant was studied. In these three patients, the con®guration was: S2 mixed roots bilaterally (channel B), and S34 bilaterally (channel A). Both channels could be used to suppress provoked hyperre¯exic contractions, with the S2 channel eective at a shorter pulse width than S34 in a majority of cases. Continuous stimulation more than doubled bladder capacity in two out of three patients during slow ®ll cystometry. Conditional stimulation was highly eective. In the one patient who used continuous stimulation at home, bladder capacity was more than doubled and the eect was comparable with anticholinergic medication. Bladder pressures 470 cm water could be achieved with intense stimulation in three patients, but detrusor-external urethral sphincter dyssynergia (DSD) prevented complete emptying. Conclusions: Neuromodulation via a SPARS was eective and may replace the need for posterior rhizotomy. However, persisting DSD may prevent complete bladder emptying and warrants further investigation.

show abstract

Short-term effect of pudendal nerve electrical stimulation on detrusor hyperreflexia in spinal cord injury patients: importance of current strength

Cited by 56 publications

References 19 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

Minimal invasive electrode implantation for conditional stimulation of the dorsal genital nerve in neurogenic detrusor overactivity

Neuromodulation through sacral nerve roots 2 to 4 with a Finetech-Brindley sacral posterior and anterior root stimulator

Contact Info

Product

Resources

About