MP52-20 OPTIMISATION OF TRANSCUTANEOUS SPINAL CORD STIMULATION IN MODULATION OF MICTURITION REFLEXES FOLLOWING SPINAL CORD INJURY

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP52-20 OPTIMISATION OF TRANSCUTANEOUS SPINAL CORD STIMULATION IN MODULATION OF MICTURITION REFLEXES FOLLOWING SPINAL CORD INJURY Hannah Houliston, Richard Nobrega, Natalia Vasquez, Frank Lee, and Sarah Knight Hannah HoulistonHannah Houliston More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Natalia VasquezNatalia Vasquez More articles by this author , Frank LeeFrank Lee More articles by this author , and Sarah KnightSarah Knight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spinal cord injury (SCI) can result in neurogenic lower urinary tract dysfunction including neurogenic detrusor over-activity (NDO) and detrusor-sphincter dyssynergia (DSD). Exciting developments in spinal cord stimulation (SCS) have demonstrated potential to improve motor function. Transcutaneous SCS (tSCS) provides a non-invasive alternative to epidural SCS, and there is preliminary evidence to suggest it can modulate spinal networks involved in micturition. However, there is ambiguity regarding optimal electrode sites and stimulation parameters. The aim of this study was to investigate optimisation of electrode site and tSCS parameters during the filling and voiding phase of the micturition cycle in people with SCI. METHODS: Ethical approval was obtained from the Research Ethics Committee. Participants were recruited if they had a supra-sacral SCI and proven NDO on most recent urodynamics. During visit 1, 1 ms tSCS pulses of increasing amplitude where administered at three randomised electrode sites; cathode between spinous process of T11-12, or L1-2, anodes at iliac crests or abdomen. External anal sphincter (EAS) and bilateral tibialis anterior EMG were recorded throughout. Optimal electrode site was selected based on motor-evoked potential response, and tolerance to stimulation. With electrodes placed at the optimal site, tSCS was applied in 5 s bursts at either 1, 15 or 30 Hz during voluntary pelvic floor contraction, relaxation and control. During visit 2, participants completed 6 cycles of urodynamics, one control cycle at the start and end, two cycles applying either 30 or 15 Hz tSCS during bladder filling, and two cycles applying either 1 or 15 Hz tSCS during voiding. RESULTS: Six participants were recruited (4 male, 2 female), with mean age 50±20 years old. 4 had an incomplete cervical and 2 an incomplete thoracic SCI. All participants tolerated the stimulation, and there were no adverse events. Optimal electrode sites were cathode L1-2, anode abdomen (n=2), cathode T11-12, anode iliac crest (n=2), cathode L1-2, anode iliac crest (n=1) and cathode T11-12, anode abdomen (n=1). Preliminary analysis of EMG data indicates that tSCS may enhance voluntary contraction of EAS. In addition, tSCS during the filling phase may increase bladder capacity. Further analysis is on-going. CONCLUSIONS: tSCS is an exciting new development which may improve bladder and bowel function following SCI. Our initial studies optimising electrode positioning and parameters will be used to investigate the use of tSCS in a further study combining it with pelvic floor muscle training. Source of Funding: International Spinal Research Trust Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e710 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Houliston More articles by this author Richard Nobrega More articles by this author Natalia Vasquez More articles by this author Frank Lee More articles by this author Sarah Knight More articles by this author Expand All Advertisement PDF downloadLoading ...