High frequency sacral root nerve block allows bladder voiding.
High frequency sacral root nerve block allows bladder voiding.
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DOI：
10.1002/nau.21075
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发表时间：
2012-06
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 S.;Bhadra, Narendra;Gustafson, Kenneth J.
脊髓损伤后的反射性外尿道括约肌（EUS）活动失调可阻止膀胱排尿，导致严重的医疗并发症。不可逆的括约肌切开术或神经切断术可以防止EUS激活并允许膀胱排尿，但可能导致尿失禁或骶反射丧失。我们研究了千赫兹频率（KF）的骶神经根电传导阻滞是否可以防止EUS激活，并允许膀胱排尿。刺激双侧S2骶神经根产生膀胱压力。近端刺激一个S1神经根（20 Hz双相脉冲串）以诱发EUS压力，模拟最差情况的协同失调EUS反射。KF波形（12.5 kHz双相方波）应用于S1神经根远端植入的电极，阻断神经传导，防止EUS压力增加并允许排尿。在单次、有限持续时间试验中，应用KF波形使膀胱排尿从3 ± 6%增加到59 ± 12%。通过重复或延长试验持续时间，排尿量可增加至初始膀胱容量的82 ± 9%。骶神经阻滞可以防止EUS激活，并允许完全膀胱排尿，可能消除神经切开术的需要。消除神经切开术的要求可以提高患者对膀胱排尿神经假体的接受度，提高患者的生活质量并降低患者护理成本。
Dyssynergic reflexive external urethral sphincter (EUS) activity following spinal cord injury can prevent bladder voiding, resulting in significant medical complications. Irreversible sphincterotomies or neurotomies can prevent EUS activation and allow bladder voiding, but may cause incontinence or loss of sacral reflexes. We investigated whether kilohertz frequency (KF) electrical conduction block of the sacral roots could prevent EUS activation and allow bladder voiding. The S2 sacral nerve roots were stimulated bilaterally to generate bladder pressure in 6 cats. One S1 nerve root was stimulated proximally (20 Hz biphasic pulse trains) to evoke EUS pressure, simulating worst-case dyssynergic EUS reflexes. KF waveforms (12.5 kHz biphasic square wave) applied to an electrode implanted distally on the S1 nerve root blocked nerve conduction, preventing the increase in EUS pressure and allowing voiding. Applying KF waveforms increased bladder voiding in single, limited-duration trials from 3 ± 6% to 59 ± 12%. Voiding could be increased to 82 ± 9% of the initial bladder volume by repeating or increasing the duration of the trials. Sacral nerve block can prevent EUS activation and allow complete bladder voiding, potentially eliminating the need for a neurotomy. Eliminating neurotomy requirements could increase patient acceptance of bladder voiding neuroprostheses, increasing patient quality of life and reducing the cost of patient care.
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影响因子：
3.4
作者：
Bhadra, N;Kilgore, KL
通讯作者：
Kilgore, KL
影响因子：
6.6
作者：
Abdel-Gawad, M;Boyer, S;Elhilali, MM
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Elhilali, MM
影响因子：
2
作者：
Bhadra, N;Gr端newald, V;Mortimer, JT
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Mortimer, JT
影响因子：
6.6
作者：
LI, JS;HASSOUNA, M;ELHILALI, MM
通讯作者：
ELHILALI, MM
影响因子：
2.2
作者：
Sanders, P. M. H.;IJzerman, M. J.;Gustafson, K. J.
通讯作者：
Gustafson, K. J.