Abstract
ObjectiveTo determine the inhibitory effect on bladder activity induced by bilateral pudendal neuromodulation.MethodsIn 10 cats under anesthesia, two tripolar cuff electrodes were implanted bilaterally on the pudendal nerves for stimulation. A double lumen catheter was inserted into the bladder through the urethra to infuse saline and measure bladder pressure. During repeated cystometrograms (CMGs) pudendal nerve stimulation (PNS: 5 Hz, 0.2 ms, 5–15 min) was applied unilaterally or bilaterally at 1- or 2-times intensity threshold (T) for inducing anal sphincter twitching. PNS inhibition was indicated by the increase in bladder capacity measured by CMGs.ResultsUnilateral PNS at 1T did not significantly increase bladder capacity, but at 2T significantly (p < 0.05) increased bladder capacity by about 30%. Bilateral PNS at 1T also failed to increase bladder capacity, but at 2T significantly (p < 0.05) increased bladder capacity by about 60%, indicating an additive effect induced by the bilateral 2T PNS. Unilateral 1T PNS did not enhance the inhibitory effect induced by contra-lateral 2T PNS.ConclusionThis study in anesthetized cats reveals that an additive inhibition of reflex bladder activity can be induced by bilateral pudendal neuromodulation, indicating that bilateral PNS might achieve better therapeutic efficacy in treating overactive bladder (OAB) than unilateral PNS.
Highlights
Sacral neuromodulation is approved by FDA as an effective therapy for overactive bladder (OAB)
This study examined the influence of unilateral and bilateral pudendal nerve stimulation (PNS) on reflex bladder activity with the goal of establishing how the magnitude of neuromodulation is influenced by simultaneous inputs from bilateral pudendal nerves
Stimulation on the left and right sides produced similar reponses. These results indicate that the suppression of reflex bladder activity by electrical stimulation of afferents in the pudendal nerve occurs primarily ipsilaterally and that a synergistic or supra-additive interaction of these independent inhibitory mechanisms induced by bilateral PNS would contribute relatively little to the efficacy of pudendal neuromodulation
Summary
Sacral neuromodulation is approved by FDA as an effective therapy for overactive bladder (OAB). This therapy is only successful in about 70% of OAB patients (van Kerrebroeck et al, 2007). The standard sacral neuromodulation therapy implants a single electrode lead unilaterally on one sacral S3 spinal root. Implantation of a second electrode lead on the sacral S3 spinal root on the other side is only performed when unilateral sacral neuromodulation fails to treat OAB effectively (Marcelissen et al, 2011). Bilateral Pudendal Neuromodulation unilateral sacral neuromodulation could be treated effectively by bilateral sacral neuromodulation (Marcelissen et al, 2011) It is not clear whether the additional beneficial effect is caused by the stimulation delivered via the second electrode alone or by interaction between the left and right neuromodulation
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