Transcutaneous electrical stimulation of urinary bladder in patients with spinal cord injuries

Abstract

The treatment of neurogenic dysfunctions of micturition, both surgical and conservative, aims primarily to protect upper urinary tract function. This goal can be achieved by lowering intravesical pressure and increasing urinary bladder capacity in the urine collection phase or by facilitating bladder emptying. The objective of this paper was to assess the outcome of transcutaneous stimulation of the urinary bladder in the treatment of neurogenic disorders of micturition. The effect of urinary bladder stimulation was assessed in 22 patients (4 females, 18 males) with spinal injuries (19 with injuries to the lumbo-sacral spine and 3 with cervical spine injuries) treated at the Department of Rehabilitation of the Military Hospital in Bydgoszcz, Poland, in 2006 and 2007. The treatment consisted of 30 procedures of transcutaneous electrical stimulation of the urinary bladder. A pulsed sinusoid current was used with a pulse duration of 200 ms, break duration of 1,000 ms, intensity of 15-20 mA, frequency of 50 Hz, and duration of stimulation of 15 min. A urodynamic study was carried out in each patient at baseline and on completion of the electrical stimulation therapy (immediately and after 2 months). Electrical stimulation of the neurogenic urinary bladder produced increases in the cystometric bladder capacity and reduction in the amount of residual urine (72% of patients), with reduction of intravesical pressure at peak urine flow (59% of the patients). The dynamic aspects of micturition also improved with increased peak voiding velocity in 77.3% of the patients. More than half of the patients (57%) still had elevated intravesical pressures during micturition that posed a risk to the function of the upper urinary tract despite significant decreases following the stimulation therapy. Micturition, which was absent at baseline, was restored in three patients. No local complications were observed. Transcutaneous electrical stimulation of the urinary bladder in patients with neurogenic bladder dysfunction improves lower urinary tract function. Urodynamic studies executed 2 months after finishing TES show persistent results.