Genital Nerve Stimulation is Tolerable and Effective for Bladder Inhibition in Sensate Individuals with Incomplete SCI

Overview

Journal J Spinal Cord Med

Date 2017 Feb 11

PMID 28185483

Citations 8

Authors

Steven W Brose

Dennis J Bourbeau

Kenneth J Gustafson

Affiliations

Soon will be listed here.

Abstract

Background: Neurogenic detrusor overactivity after spinal cord injury (SCI) causes urinary incontinence and reduces bladder capacity. Surface electrical genital nerve stimulation (GNS) acutely inhibits reflex bladder contractions. The stimulation amplitude selected for GNS is typically twice the amplitude that is required to evoke the pudendal-anal reflex. There is concern about the ability of persons with sensation to comfortably tolerate effective levels of GNS. The objective of this work is to determine if persons with incomplete SCI are able to tolerate acute GNS for bladder inhibition.

Methods: Twenty-four subjects with neurogenic detrusor overactivity, SCI, and pelvic sensation were enrolled in this case series. The setting was the Spinal Cord Injury Service of a Veterans Affairs Medical Center. Primary outcome measures were sensation threshold and tolerable stimulation amplitude; secondary outcome measures were bladder capacity and bladder contraction inhibition.

Results: GNS was tolerable up to 30±16 mA (range 8 mA to ≥60 mA) at amplitudes greater than twice the pudendal-anal (PA) reflex threshold, which was 8±5 mA (range 4 mA to 20 mA). Twelve subjects tolerated GNS at greater than twice the PA, six tolerated 1-1.5 times the PA, and five had no identifiable PA. GNS at tolerable amplitudes inhibited reflexive bladder contractions or increased bladder capacity 135±109 mL (n=23). GNS did not cause autonomic dysreflexia or intolerable spasticity.

Conclusions: GNS is tolerable at amplitudes that effectively inhibit neurogenic detrusor overactivity in individuals with pelvic sensation. GNS therefore is a tool with potential clinical applications for persons with preserved sensation.

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References

Bower W, Moore K, Adams R . A pilot study of the home application of transcutaneous neuromodulation in children with urgency or urge incontinence. J Urol. 2001; 166(6):2420-2. View

Kirkham A, Shah N, Knight S, Shah P, Craggs M . The acute effects of continuous and conditional neuromodulation on the bladder in spinal cord injury. Spinal Cord. 2001; 39(8):420-8. DOI: 10.1038/sj.sc.3101177. View

Dalmose A, Rijkhoff N, Kirkeby H, Nohr M, Sinkjaer T, Djurhuus J . Conditional stimulation of the dorsal penile/clitoral nerve may increase cystometric capacity in patients with spinal cord injury. Neurourol Urodyn. 2003; 22(2):130-7. DOI: 10.1002/nau.10031. View

Hansen J, Media S, Nohr M, Biering-Sorensen F, Sinkjaer T, Rijkhoff N . Treatment of neurogenic detrusor overactivity in spinal cord injured patients by conditional electrical stimulation. J Urol. 2005; 173(6):2035-9. DOI: 10.1097/01.ju.0000158160.11083.1b. View

Wheeler Jr J, Walter J, Sibley P . Management of incontinent SCI patients with penile stimulation: preliminary results. J Am Paraplegia Soc. 1994; 17(2):55-9. DOI: 10.1080/01952307.1994.11735917. View

Opisso E, Borau A, Rodriguez A, Hansen J, Rijkhoff N . Patient controlled versus automatic stimulation of pudendal nerve afferents to treat neurogenic detrusor overactivity. J Urol. 2008; 180(4):1403-8. DOI: 10.1016/j.juro.2008.06.023. View

Goldman H, Amundsen C, Mangel J, Grill J, Bennett M, Gustafson K . Dorsal genital nerve stimulation for the treatment of overactive bladder symptoms. Neurourol Urodyn. 2007; 27(6):499-503. PMC: 3646571. DOI: 10.1002/nau.20544. View

Anderson K . Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2005; 21(10):1371-83. DOI: 10.1089/neu.2004.21.1371. View

Lee Y, Creasey G, Lim H, Song J, Song K, Kim J . Detrusor and blood pressure responses to dorsal penile nerve stimulation during hyperreflexic contraction of the bladder in patients with cervical cord injury. Arch Phys Med Rehabil. 2003; 84(1):136-40. DOI: 10.1053/apmr.2003.50075. View

10.

Opisso E, Borau A, Rijkhoff N . Subject-controlled stimulation of dorsal genital nerve to treat neurogenic detrusor overactivity at home. Neurourol Urodyn. 2013; 32(7):1004-9. DOI: 10.1002/nau.22359. View

11.

Wheeler Jr J, Walter J, Zaszczurynski P . Bladder inhibition by penile nerve stimulation in spinal cord injury patients. J Urol. 1992; 147(1):100-3. DOI: 10.1016/s0022-5347(17)37145-8. View

12.

Gray S, Anderson M, Dublin S, Hanlon J, Hubbard R, Walker R . Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015; 175(3):401-7. PMC: 4358759. DOI: 10.1001/jamainternmed.2014.7663. View

13.

Horvath E, Yoo P, Amundsen C, Webster G, Grill W . Conditional and continuous electrical stimulation increase cystometric capacity in persons with spinal cord injury. Neurourol Urodyn. 2009; 29(3):401-7. PMC: 3109497. DOI: 10.1002/nau.20766. View

14.

Lindstrom S, Fall M, Carlsson C, Erlandson B . The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation. J Urol. 1983; 129(2):405-10. DOI: 10.1016/s0022-5347(17)52127-8. View

15.

Lee Y, Kim J, Im H, Lee K, Kim S, Hur D . Semiconditional electrical stimulation of pudendal nerve afferents stimulation to manage neurogenic detrusor overactivity in patients with spinal cord injury. Ann Rehabil Med. 2012; 35(5):605-12. PMC: 3309249. DOI: 10.5535/arm.2011.35.5.605. View

16.

Walter J, Sidarous R, Robinson C, Wheeler J, Wurster R . Comparison of direct bladder and sacral nerve stimulation in spinal cats. J Rehabil Res Dev. 1992; 29(2):13-22. DOI: 10.1682/jrrd.1992.04.0013. View

17.

Martens F, Heesakkers J, Rijkhoff N . Minimal invasive electrode implantation for conditional stimulation of the dorsal genital nerve in neurogenic detrusor overactivity. Spinal Cord. 2010; 49(4):566-72. DOI: 10.1038/sc.2010.134. View

18.

Fjorback M, Hansen J, Dalmose A, Rijkhoff N, Sinkjaer T . A portable device for experimental treatment of neurogenic detrusor overactivity. Neuromodulation. 2011; 6(3):158-65. DOI: 10.1046/j.1525-1403.2003.03024.x. View

19.

Salahudeen M, Hilmer S, Nishtala P . Comparison of anticholinergic risk scales and associations with adverse health outcomes in older people. J Am Geriatr Soc. 2015; 63(1):85-90. DOI: 10.1111/jgs.13206. View

20.

Previnaire J, Soler J, Perrigot M, Boileau G, Delahaye H, SCHUMACKER P . Short-term effect of pudendal nerve electrical stimulation on detrusor hyperreflexia in spinal cord injury patients: importance of current strength. Paraplegia. 1996; 34(2):95-9. DOI: 10.1038/sc.1996.17. View