Abstract
ABSTRACTBackground:Compared to conventional therapies, sacral neuromodulation (SNM) may offer an alternative, non-destructive treatment for SCI patients with bladder dysfunction. Understanding bladder response to SNM treatment for SCI in different phases may yield new insights for innovative use of this promising technique.Materials and Methods:Female Sprague-Dawley rats were used in this study to examine the effects of acute SNM on bladder reflex in complete SCI rats. All rats were anesthetized and set up for continuous saline infusion. Acute SNM treatment was implemented for about 6 hours for each rat. Cystometric parameters, including time between contractions, contraction duration, bladder peak pressure, and number of uninhibited contractions, were analyzed and compared within rats before and after SNM treatment.Results:For the spinally transected rats during early phase (less than two weeks post spinalization), the time between contractions and contraction duration both increased after SNM treatments, yet the increased amplitude was about or less than 20%. For the spinally transected rats with a longer days survival (about two to four weeks post spinalization), the time between contractions and contraction duration substantially increased after SNM treatment and the changes for their average values were more than 90%. For the spinally transected rats with a much longer days survival (more than five weeks post spinalization), the time between contractions and contraction duration increased after SNM treatments, yet the magnitude of changes were less than 30%.Conclusion:The present study suggested that the significant effectiveness of SNM for complete SCI played its role after the spinal shock phase and prior to the development of detrusor overactivity. It indicated that the time point of SNM treatment is necessary to be paid attention.
Highlights
Supra-sacral lesions to the spinal cord nearly always lead to serious disruption of lower urinary tract function (LUTD)
The spinal cord injury (SCI) rats were analyzed individually with bladder infusion because the condition of rats and the parameters used in electrical stimulation are not identical, and it is necessary to evaluate the effect of the therapeutic neuromodulation for each rat
It is assumed that the effectiveness of the sacral neuromodulation (SNM) treatment to some extent was determined by the dynamic neurologic process and reorganization or neuroplasticity that might occur after a spinal lesion, emphasizing the significance of the time point of SNM treatment
Summary
Supra-sacral lesions to the spinal cord nearly always lead to serious disruption of lower urinary tract function (LUTD). The locations of stimulation used in patients with supra-sacral spinal cord injury (SCI) or disease have been reported in a number of ways, including the bladder wall [1], the pudendal or dorsal genital nerve [2, 3], the conus medullaris [4], the tibial nerve [5], the sacral anibju | SNM in Treating Rats with Complete SCI terior roots [6], or the mixed sacral nerves [7, 8] Only the latter two sites have demonstrated clinical significance. It indicated that the time point of SNM treatment is necessary to be paid attention
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