Multiple Reflex Pathways Contribute to Bladder Activation by Intraurethral Stimulation in Persons With Spinal Cord Injury
Multiple Reflex Pathways Contribute to Bladder Activation by Intraurethral Stimulation in Persons With Spinal Cord Injury
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DOI：
10.1016/j.urology.2017.07.041
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发表时间：
2017-11-01
期刊：
影响因子：
2.1
通讯作者：
Grill, Warren M.
中科院分区：
文献类型：
--
作者：
McGee, Meredith J.;Swan, Brandon D.;Grill, Warren M.
目的观察脊髓损伤（SCI）患者尿道近端和远端2个部位电共刺激对尿动力学的影响。这项工作的动机是临床前研究结果，选择性地共同刺激颅尿道感觉神经和生殖背神经，分别支配尿道的近端和远端部分，增加反射膀胱的激活和排尿效率。材料与方法对慢性脊髓损伤患者在尿动力学过程中进行尿道传入电共刺激。测量不同频率的多尿道刺激对膀胱压力和盆底肌电图活动的影响。结果肌电图活动表明，多种反射通路通过刺激参与膀胱激活。刺激引起的反射性膀胱收缩大小与刺激部位或反射激活和刺激频率有关。结论阴部神经传入是恢复失禁膀胱控制的一个有希望的靶点，不同频率的刺激可用于治疗尿失禁，增加膀胱容量或产生刺激引起的膀胱收缩以实现按需排尿。本研究发现，当单一传入反射通路刺激不足时，多种传入反射通路的共同刺激可以增强脊髓回路的激活，并可能改善脊髓损伤患者的膀胱排空。(c) 2017 Elsevier Inc.
OBJECTIVE To measure the urodynamic effects of electrical co-stimulation of 2 individual sites in the proximal and distal urethra in persons with spinal cord injury (SCI). This work was motivated by preclinical findings that selective co-stimulation of the cranial urethral sensory nerve and the dorsal genital nerve, which innervate the proximal and distal portions of the urethra, respectively, increased reflex bladder activation and voiding efficiency.MATERIALS AND METHODS Electrical co-stimulation of urethral afferents was conducted in persons with chronic SCI during urodynamics. The effects of different frequencies of intraurethral stimulation at multiple urethral locations on bladder pressure and pelvic floor electromyographic activity were measured.RESULTS Electromyographic activity indicated that multiple reflex pathways were recruited through stimulation that contributed to bladder activation. The size of reflex bladder contractions evoked by stimulation was dependent on stimulation location or reflex activated and stimulation frequency.CONCLUSION Pudendal nerve afferents are a promising target to restore lost bladder control, as stimulation with different frequencies may be used to treat urinary incontinence and increase continent volumes or to generate stimulation-evoked bladder contractions for on-demand voiding. This work identified that co-stimulation of multiple afferent reflex pathways can enhance activation of spinal circuits and may enable improved bladder emptying in SCI when stimulation of a single pathway is not sufficient. (c) 2017 Elsevier Inc.