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

Case Western Reserve University, Cleveland, Ohio, United States
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 03/2002; 83(2):273-7. DOI: 10.1053/apmr.2002.28817
Source: PubMed


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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    • "Lee et al.13,19 reported that the electrical stimulation of the pudendal nerve afferent suppressed the neurogenic detrusor overactive contractions effectively on spinal cord injury of diverse severities and levels, and pudendal afferent nerve electrical stimulation could be used not only in laboratories but also at home. Kirkham et al.10 compared the effect of the suppression of neurogenic detrusor overactivity by dorsal penile nerve stimulation, which was performed either continuously or conditionally in the identical subjects, and reported that conditional stimulation was more effective. "
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    ABSTRACT: 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. 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. 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. 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.
    Full-text · Article · Oct 2011 · Annals of Rehabilitation Medicine
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    • "Without stimulation, bladder contractions are not suppressed (H). (Lee and Creasey, 2002). cord injury patients. "
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    ABSTRACT: The management of urinary tract dysfunction is crucial for the health and well-being of people with spinal cord injury. Devices, specifically catheters, play an important role in the daily regime of bladder management for most people with spinal cord injury. However, the high incidence of complications associated with the use of catheters, and the fact that the spinal segments involved in lower urinary tract control remain intact in most cord-injured people, continue to motivate research into devices that could harness the nervous system to provide greater control over lower urinary tract function. Mechanical devices discussed in this review include catheters, artificial urethral sphincters, urethral stents and intraurethral pumps. Additionally, many attempts to restore control of the lower urinary tract with electrical stimulation have been made. Stimulation sites have included: inside the bladder, bladder wall, thigh, pelvic floor, dorsal penile nerve, pelvic nerve, tibial nerve, sacral roots, sacral nerves and spinal cord. Catheters and sacral root stimulators are two techniques whose efficacy is well established. Some approaches have proven less successful and others are still in the development stage. Modifications to sacral root stimulation including posterior root stimulation, anodal blockade and high-frequency blockade as well as new techniques including intraspinal microstimulation, urethral afferent stimulation and injectable microstimulators are also discussed. No single device has yet restored the control and function of the lower urinary tract to the pre-injury state, but new techniques are bringing this possibility closer to reality.
    Full-text · Article · Feb 2006 · Progress in brain research
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    ABSTRACT: Objectives: To review the up-to-date literature of the mostly used con- servative treatment modalities in patients with neurogenic bladder. Methods: material from literature on conservative management in patients with neurogenic bladder was reviewed. Pubmed search results and recent books were consulted. Results: The conservative treatment is in almost all cases the first and will remain the primary choice in the majority of patients with neuro- genic bladder. Treatment will depend on the type of underlying disease, on the bladder dysfunction, its natural evolution but also on the patients' general condition, and the available resources. Behavioural training, catheters, external appliances, drugs and electrical stimulation are pre- sented, their indications and limitations. Conclusions: Conservative treatment is the mainstay in neurogenic blad- der management. It offers different methods which permit to success- fully treat most symptoms and conditions in this prevalent LUT pathology.
    Preview · Article · Aug 2008 · European Urology Supplements
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