424 MULTI-SYSTEMS NEUROREHABILITATION IMPROVES BLADDER FUNCTION AFTER SPINAL CORD INJURY

Abstract

You have accessJournal of UrologyBladder and Urethra: Anatomy, Physiology and Pharmacology1 Apr 2011424 MULTI-SYSTEMS NEUROREHABILITATION IMPROVES BLADDER FUNCTION AFTER SPINAL CORD INJURY Maya Horst, Rubia Van den Brand, Janine Heutschi, Pavel Musienko, Rita Gobet, Tullio Sulser, Grégoire Courtine, and Daniel Eberli Maya HorstMaya Horst Zurich, Switzerland More articles by this author , Rubia Van den BrandRubia Van den Brand Zurich, Switzerland More articles by this author , Janine HeutschiJanine Heutschi Zurich, Switzerland More articles by this author , Pavel MusienkoPavel Musienko Zurich, Switzerland More articles by this author , Rita GobetRita Gobet Zurich, Switzerland More articles by this author , Tullio SulserTullio Sulser Zurich, Switzerland More articles by this author , Grégoire CourtineGrégoire Courtine Zurich, Switzerland More articles by this author , and Daniel EberliDaniel Eberli Zurich, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.514AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neurogenic bladder represents a major cause of morbidity in patients with spinal cord injuries (SCI). A combination of robotically-assisted locomotor training, pharmacological and epidural electrical stimulations has been shown to restore walking and even running capacities in paralyzed rats. We investigated the potential of this multi-systems neurorehabilitation to influence the plasticity of bladder innervation and therewith to counteract the formation of a neuropathic bladder. METHODS Adult Lewis rats (n=12) were assigned randomly to a spinal cord injured (n=8) and to a control noninjured (n=4) group. Four rats in the SCI group were trained using locomotor permissive systems while four rats only received daily stretching of the paralyzed hindlimbs. The SCI consisted of two lateral hemisections (T7 and T10), on opposite side, thus completely interrupting all direct supraspinal inputs. After 8 weeks bladder function was evaluated by urodynamics. Upper urinary tract function was determined by serum creatinine and cystatin C levels. Kidneys and bladders were harvested for morphological and histological investigations. Nerve densities and subtype analysis was perfomed by immunohistochemestry using PGP 9.5, neuropeptide Y and neurofilament 200. RESULTS Bladder capacity increased 3-fold in trained rats and 7-fold in nontrained rats with a low bladder pressure and normal compliance in all groups. Nontrained rats showed a strong detrusor overactivity associated with an increased detrusor thickness (p<0.05) and decreased connective tissue to smooth muscle ratio of the bladder wall (p<0.05). In constrast, detrusor and bladder properties in trained rats were overall similar to non-injured rats. Renal function and kidney size were similar in all groups. In trained rats afferent and efferent innervation was increased slightly while there was a significant decrease in nerve density in untrained rats compared to healthy animals (p<0.05). The afferent A-fiber fraction was increased in nontrained compared to trained rats (p<0.05). CONCLUSIONS Our results reveal that following a severe SCI that leads to complete paralysis, multi-systems neurorehabilitation not only can restore impressive walking capacities but can also counteract the formation of an overactive neuropathic bladder. Application of this therapeutic interventions to patients might lead to a new viable clinical strategy for improving bladder function and preventing long term complications in individuals with severe paraplegia. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e171 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maya Horst Zurich, Switzerland More articles by this author Rubia Van den Brand Zurich, Switzerland More articles by this author Janine Heutschi Zurich, Switzerland More articles by this author Pavel Musienko Zurich, Switzerland More articles by this author Rita Gobet Zurich, Switzerland More articles by this author Tullio Sulser Zurich, Switzerland More articles by this author Grégoire Courtine Zurich, Switzerland More articles by this author Daniel Eberli Zurich, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...