Clinical and experimental study of electrical stimulation for urinary incontinence.

对13例逼尿肌功能亢进所致尿失禁患者采用经皮盆底电刺激治疗。经皮电极植入后，使用自行研制的便携式体外电刺激器进行慢性刺激。最大电刺激4~16周后，13例患者中有10例尿失禁得到改善。在这10例患者中，有2例主观性大小便失禁消失。尿流动力学检查显示所有患者起初不稳定收缩时尿量增加。通过这一过程，可以抑制逼尿肌过度活动。在慢性刺激过程中，刺激似乎是恒定的。该术式可为慢性治疗提供稳定可靠的刺激，可作为治疗尿失禁的一种替代方法。[Int.Uro.Nephrol，24：277-282,1992，Eur.Urol，23：413-416,1993，Frontiers Med.Biol.Engig，5：1-10,1993，Br.J.Urol.，1994 in Press.]我们还探讨了盆底刺激的基本机制。本实验测定了兔膀胱局部去甲肾上腺素(NE)的含量。急性盆底电刺激后，膀胱底和膀胱体中去甲肾上腺素含量均显著升高。NE含量在停止刺激后1~2小时内持续升高。基于这些发现，在EPFS期间，腹下神经将在膀胱抑制中发挥重要作用。[J.Urol，150：235-238,1993，J.Urol，151：774-775,1994.]

Electrical pelvic floor stimulation using a percutaneous procedure was carried out on 13 patients suffering from urinary incontinence due to overactive detrusor function. After the percutaneous electrode implantation, chronic stimulation was carried out employing portable external electrical stimulator which we developed. 4 to 16 weeks of maximal electrical stimulation improved urinary incontinence in 10 of 13 patients. In 2 of these 10 patients, incontinence disappeared subjectively. Urodynamic investigations demonstrated a increased volume at first unstable contraction in all patients. Inhibition of detrusor overactivity was obtained from this procedure. The stimulation appeared to be constant during chronic stimulation. This procedure can provide stable and reliable stimulation for chronic treatment and can be an alternative for the treatment of urinary incontinence. [Int.Urol.Nephrol., 24 : 277-282, 1992, Eur.Urol., 23 : 413-416, 1993, Frontiers Med.Biol.Engig., 5 : 1-10, 1993, Br.J.Urol., 1994 in press.]We also investigated the basic mechanism of the pelvic floor stimulation. Experiments were carried out to evaluate the regional norepinephrine (NE) content of the rabbit bladder. Content of NE increased in both the bladder base and body significantly after the acute electrical pelvic floor stimulation. Increased NE content sustained 1 to 2 hours after ceasing the stimulation. Based on these findings, during EPFS the hypogastric nerve would play a significant role in bladder inhibition. [J.Urol., 150 : 235-238, 1993, J.Urol., 151 : 774-775, 1994.]