Ann Rehabil Med.  2011 Oct;35(5):605-612. 10.5535/arm.2011.35.5.605.

Semiconditional Electrical Stimulation of Pudendal Nerve Afferents Stimulation to Manage Neurogenic Detrusor Overactivity in Patients with Spinal Cord Injury

• Lee YH
• Kim JM
• Im HT
• Lee KW
• Kim SH
• Hur DM

• KMID: 2267221
• DOI: http://doi.org/10.5535/arm.2011.35.5.605

Abstract

OBJECTIVE
To evaluate the effect of semiconditional electrical stimulation of the pudendal nerve afferents for the neurogenic detrusor overactivity in patients with spinal cord injury. Forty patients (36 males, 4 males) with spinal cord injury who had urinary incontinence and frequency, as well as felt bladder contraction with bladder filling sense or autonomic dysreflexic symptom participated in this study. METHOD: Patients with neurogenic detrusor overactivity were subdivided into complete injury and incomplete injury groups by ASIA classification and subdivided into tetraplegia and paraplegia groups by neurologic level of injury. Bladder function, such as bladder volumes infused to the bladder until the first occurrence of neurogenic detrusor overactivity (V(ini)) and the last contraction suppressed by electrical stimulation (V(max)) was measured by water cystometry (CMG) and compared with the results of each subgroup.
RESULTS
Among the 40 subjects, 35 patients showed neurogenic detrusor overactivity in the CMG study. Among these 35 patients, detrusor overactivity was suppressed effectively by pudendal nerve afferent electrical stimulation in 32 patients. The infusion volume until the occurrence of the first reflex contraction (V(ini)) was 99.4+/-80.3 ml. The volume of saline infused to the bladder until the last contraction suppressed by semiconditional pudendal nerve stimulation (V(max)) was 274.3+/-93.2 ml, which was significantly greater than V(ini). In patients with good response to the pudendal nerve afferent stimulation, the bladder volume significantly increased by stimulation in all the patients.
CONCLUSION
In this study, semiconditional electrical stimulation on the dorsal penile afferent nerve could effectively inhibit neurogenic detrusor overactivity and increase bladder volume in patients with spinal cord injury.

Keyword

Spinal cord injuries; Detrusor overactivity; Pudendal nerve; Electrical stimulation

MeSH Terms

Asia
Contracts
Electric Stimulation
Humans
Male
Paraplegia
Pudendal Nerve
Quadriplegia
Reflex
Spinal Cord
Spinal Cord Injuries
Urinary Bladder
Urinary Incontinence
Water
Water

Figure

• 

  Fig. 1 CMG findings in different methods of pudendal afferent nerve electrical stimulation. Bold line represent the period of electrical stimulation. Arrow represents the switch control. (A) Continuous method applied the electrical stimulation throughout bladder filling. (B) Conditional method applied the electrical stimulation on each overactive contraction (C). Semiconditional stimulation started with the first bladder contraction and continued in a cyclic pattern with preset on-off time. The second arrow represents the manipulation of the equipment for intensity change.

• 

  Fig. 2 Schematic representation of CMG with electrical stimulation to the pudendal nerve. C1, C2...Cn: Overactive bladder contraction. S1, S2...Sn: 50 seconds electrical stimulation to pudendal nerve at each overactive bladder contraction. T1, T2...Tn: Duration of suppression after stimulation at each overactive contraction. Duration measured from the end of the burst to the start of the next contraction. Vini: The infusion volume until the occurrence of the first overactive contraction. Vmax: The infusion volume to the bladder until the last contraction suppressed by semiconditional pudendal nerve stimulation.

• 

  Fig. 3 CMG findings of semiconditional pudendal nerve stimulation to neurogenic detrusor overactivity. (A) When the switch-off duration was set to 10 seconds after 50 second burst of the current, overactive contractions suppressed only during 'on' period and occurred during every 'off' period. (B) When the switch-off duration was shortened to 5 seconds in the same patient, overactive detrusor contractions were effectively suppressed continuously until the infused volume reached approximately 4 times of Vini.

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