Self-controlled dorsal penile nerve stimulation to inhibit bladder hyperreflexia in incomplete spinal cord injury: a case report.

Department of Rehabilitation Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.44). 03/2002; 83(2):273-7. DOI: 10.1053/apmr.2002.28817
Source: PubMed

ABSTRACT Intermittent catheterization is not always successful in achieving continence in spinal cord injury (SCI) and often requires adjunctive methods. Electric stimulation of sacral afferent nerves reduces hyperactivity of the bladder. This report describes application of self-controlled dorsal penile nerve stimulation for bladder hyperreflexia in incomplete SCI. The patient was a 33-year-old man with C6 incomplete quadriplegia who managed his bladder with intermittent self-catheterization and medication. Despite this, he continued to have reflex bladder contractions that he could feel but could not catheterize himself in time to prevent incontinence. We performed cystometry with dorsal penile nerve stimulation and analyzed data of home use of stimulation. During cystometry, the suppressive effect of electric stimulation on hyperreflexic contractions was reliable and reproducible. The patient could start stimulation on sensing bladder contraction, and the suppression of reflex contraction lasted several minutes after stopping brief stimulation. When using stimulation at home, the rate of leakage between catheterization decreased, and catheterized volume increased significantly.

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    ABSTRACT: The aim of this report was to investigate the effect of the low pressure physiological distension of the bladder using conditional DPN stimulation of the bladder and upper urinary tract in patient with spinal cord injury. Methods Patients with low compliance bladders were admitted to the SCI units, and evaluated for the possible home use of conditional, cyclic DPN stimulation. Electrical stimulation for the suppression of the reflex contraction was applied using a portable neuromuscular stimulation system. The DPN was stimulated using circular surface electrodes with 1cm diameters. The cathode and anode were placed 2cm apart, proximally and distally, respectively, on the dorsum of the penile shaft. The stimulation parameters used were biphasic rectangular pulses of 25Hz frequency, with a 250µsec pulse width. The intensity of the stimulation used was twice that of the pudendo-anal reflex threshold. Standard water cystometry, with a filling rate between 10 - 30 ml/min, was performed to identify the suppressive effect of the DPN stimulation to the reflex contraction, and the adequate 'on-off' duration setting for the cyclic stimulation.
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    ABSTRACT: Elektrische stimulatie van de nervus dorsalis penis of clitoridis (NDPC) onderdrukt ongewenste detrusorcontracties (ODC’s) en kan worden gebruikt ter behandeling van detrusoroveractiviteit en ter preventie van incontinentie. Oppervlakte-elektroden zijn niet geschikt voor gebruik in het dagelijks leven vanwege onder andere fixatie- en hygiëneproblemen. In deze pilotstudy werd onderzocht: 1) de haalbaarheid van het inbrengen van een elektrode bij de NDPC en 2) de effectiviteit van conditionele stimulatie met verschillende stroomsterktes om ODC’s bij dwarslaesiepatiënten te onderdrukken.
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    ABSTRACT: In the past 40 years, from the aspect of its function, electrical stimulators have been improved greatly by the continuous efforts for research and development of scientists. In comparison with such improvement, except cardiac pacemakers, its effective application in clinics did not reach the anticipated level. To improve such limitations, first, the area that efforts have to be made continuously is the application of the-state-of art technique to improve the development of more improved equipment In addition to the development of the state-of-art technique, the area that research and developed should be performed is the addition of the efficacy and convenience to the already developed equipment with a low grade technology, and thus more patients could actually use them. In this presentation, the application of therapeutic electrical stimulation in clinics focused on the cases that the effect of the functional recovery was obtained by applying a basic neuromuscular electric stimulation together with tasks with a specific purpose for a certain period will be introduced.

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