1012 CORTICAL SUBSTRATE OF BLADDER CONTROL IN SCI AND THE EFFECT OF PERIPHERAL DORSAL GENITAL NERVE STIMULATION

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20101012 CORTICAL SUBSTRATE OF BLADDER CONTROL IN SCI AND THE EFFECT OF PERIPHERAL DORSAL GENITAL NERVE STIMULATION Monika-Zita Zempleni, Lars Michels, Ulrich Mehnert, Brigitte Schurch, and Spyros Kollias Monika-Zita ZempleniMonika-Zita Zempleni More articles by this author , Lars MichelsLars Michels More articles by this author , Ulrich MehnertUlrich Mehnert More articles by this author , Brigitte SchurchBrigitte Schurch More articles by this author , and Spyros KolliasSpyros Kollias More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2026AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We investigated (i) the central representation of LUT control and (ii - iii) the acute and short-term central neuromodulatory effect of peripheral dorsal genital nerve (DGN) stimulation in incomplete SCI patients using functional magnetic resonance imaging (fMRI). METHODS After ethical approval, incomplete SCI subjects (ASIA B-C) were included. During a 1st fMRI (3-Tesla) session, the urinary bladder of the patients was repeatedly filled and emptied using a catheter (i). Subsequently, filling and emptying of the bladder was repeated with simultaneous peripheral DGN stimulation (ii). Following a two-week training of twice daily external electrical DGN stimulation (square wave, 0.2 ms, 20 Hz), a 2nd fMRI session was performed (iii). RESULTS 8 subjects completed the 1st fMRI session, showing supraspinal activation in the cerebellum, thalamus, putamen, left superior and middle frontal gyrus, insula, inferior frontal gyrus, anterior cingulated gyrus (ACG), and right precuneus (i). Compared to previously investigated healthy subjects, activations were less robust and showed a feft hemisheric dominance in frontal activation. Simultaneous DGN stimulation caused a reduction in activation in the right insula, left middle frontal gyrus, right temporal and hippocampal regions, and left cerebellum (ii). 6 subjects completed the 2 weeks stimulation training and the 2nd fMRI session, which showed an increase of activation in the caudate nuclei, left parahippocampal region, right middle temporal gyrus, right insula, right orbito-frontal, middle and superior frontal gyrus, right cerebellum, and right ACG (iii). 4 of the 6 subjects showed urodynamical improvements such as improved bladder sensibility, increased compliance, and improved voluntary voiding. CONCLUSIONS Our results suggest that the central representation of bladder filling sensation is partly preserved in the subacute stage of incomplete SCI (i). However, the decreased response in right prefrontal areas and the left hemispheric dominance, might indicate diminished inhibitory micturition control as well as, compensatory or decompensatory reorganization of bladder control. We also provide evidence for a neuromodulatory effect of acute DGN stimulation (ii). DGN stimulation training induced significant neuromodulation, predominantly signal increases in areas previously described as cortical network of bladder control in healthy (iii). Correlations with the patient's urological status indicate that this neuromodulatory effect may reflect the clinical improvement following training. Zurich, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e393-e394 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Monika-Zita Zempleni More articles by this author Lars Michels More articles by this author Ulrich Mehnert More articles by this author Brigitte Schurch More articles by this author Spyros Kollias More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...