Article

Effect of Electrical Stimulation of Dorsal and Ventral Spinal Cord Roots on the Cat’s Urinary Bladder

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Abstract

Isotonic and isometric cystometry was used in anesthetized cats, some of which had their spinal cord severed previously. Reflex contraction of the bladder was obtained by electrical stimulation of the central stump of the first three sacral dorsal roots. Only in one animal out of 14, bladder contraction followed stimulation of the distal stump of sacral roots when the ventral roots had been cut. Stimulation of the distal stump of ventral roots showed that the major efferents to the bladder from the sacral cord traveled through S3. Surprisingly, consistent but smaller bladder contractions developed when the distal stumps of the ventral roots of L5 and L6 were stimulated. It was impossible to establish whether these represented activation of the detrusor or other vesical muscle, and pharmacological tests failed to differentiate between the lumbar and sacral-driven contractions.

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Article
Patients with symptoms of overactive bladder syndrome or non-obstructive urinary retention, refractory to conservative therapy, can nowadays be treated minimally invasively with sacral nerve stimulation (SNS). The use of electric currents to treat urological pathology has a long history but SNS therapy only received FDA approval in 1997. The mechanisms of action are still not known so there are different theories explaining the modulation effect. Recent studies have shown a central modulation effect. Predictive factors which can help to identify the perfect candidates are not known. Over the years the technique of SNS has become less invasive and because of two stage implantation test results have proven to be more reliable. The clinical results for this therapy have proven to be safe and effective and with the technical improvements over the years the re-operation and complication rates have decreased significantly. The clinical results have led to expanding indications because of positive effects in other symptoms. In the field of urology this has resulted in the use of SNS therapy for interstitial cystitis, neurogenic lower urinary dysfunction, and pediatric voiding dysfunction. In the field of gastro-intestinal pathology, SNS therapy is used to treat faecal incontinence and constipation.
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