Bladder voiding by combined high frequency electrical pudendal nerve block and sacral root stimulation
Bladder voiding by combined high frequency electrical pudendal nerve block and sacral root stimulation
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DOI：
10.1002/nau.20538
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发表时间：
2008-01-01
影响因子：
2
通讯作者：
Gustafson, Kenneth J.
中科院分区：
文献类型：
--
作者：
Boger, Adam;Bhadra, Narendra;Gustafson, Kenneth J.
目的：外尿道括约肌的不协调收缩在脊髓损伤的个体中是普遍的，并且可以阻止膀胱排尿。本研究的目的是证明阴部神经（PN）的完全和可逆的正弦高频交流电（HFAC）传导阻滞可以消除外尿道括约肌激活，并产生低残留膀胱排尿。方法：在4只猫，三极神经袖状电极植入双侧阴部神经和硬膜外S2神经根。记录膀胱和尿道压力、膀胱容量和流量。应用双侧HFAC测定导致双侧PN传导阻滞的电压和频率参数。骶神经根刺激提供膀胱激活。在使用和不使用HFAC PN阻滞的情况下进行了排尿试验的随机分组。在双侧PN神经切断术后进行额外的排尿试验，以消除躯体括约肌阻力，并提供完全阻滞的排尿估计值。结果：4只动物中有3只获得了有效的双侧PT阻滞和排尿。应用双侧PN HFAC刺激可将排尿从初始膀胱容量的2 +/- 4%改善至77 +/- 18%，并显著（P < 0.001）降低排尿期间的最大膀胱压力。PN阻滞试验中的排尿与PN神经切开术后的排尿无显著差异（82 +/-19%，P=0.51）。结论：这些结果表明，双侧HFAC阻滞PN可以产生有效的排尿。使用这种方法的神经假体可能为脊髓损伤的人提供一种替代的排尿方法。
Aims: Uncoordinated contraction of the external urethral sphincter is prevalent in individuals with spinal cord injury and can prevent bladder voiding. The aim of this study was to demonstrate that complete and reversible sinusoidal high frequency alternating current (HFAC) conduction block of the pudendal nerves (PN) can eliminate external urethral sphincter activation and produce low residual bladder voiding. Methods: In four cats, tripolar nerve cuff electrodes were implanted bilaterally on both pudendal nerves and on both extradural S2 roots. Bladder and urethral pressures, bladder volumes and flow were recorded. Bilateral HFAC was applied to determine voltage and frequency parameters resulting in bilateral PN conduction block. Sacral root stimulation provided bladder activation. Randomized sets of voiding trials were conducted with and without HFAC PN block. Additional voiding trials were conducted following bilateral PN neurotomy to eliminate somatic sphincter resistance and provide an estimate of voiding with complete block. Results: Effective bilateral PT block and voiding was obtained in three of four animals. Application of bilateral PN HFAC stimulation improved voiding from 2 +/- 4% to 77 +/- 18% of the initial bladder volume and significantly (P < 0.001) reduced maximum bladder pressure during voiding. Voiding in trials with PN block was not significantly different from voiding following PN neurotomy (82 +/- 19%, P=0.51). Conclusions: These results demonstrate that bilateral HFAC block of the PN can produce effective voiding. Neural prostheses using this approach may provide an alternative method for producing micturition for people with spinal cord injury.