Non-invasive neuromodulation for bowel, bladder and sexual restoration following spinal cord injury: A systematic review.

Bowel, bladder and sexual dysfunctions are widespread among people with spinal cord injury (SCI) and significantly impact their health and quality of life. Any non-invasive intervention which offers clinical benefits and safety is an advantage in restoring these functions. Despite the potential of non-invasive neuromodulation to improve the clinical outcomes in people with SCI, its characteristics are poorly defined, and reviews of efficacy are scarce in the literature. This study aimed to perform a systematic literature review of clinical studies investigating the use of non-invasive neuromodulation in restoring bowel, bladder and sexual functions following SCI. Electronic databases were searched, including the PubMed/Medline, EMBASE, Web of Science, Scopus and Cochrane databases, along with the reference lists of retrieved publications. Studies were eligible for inclusion if they adopted a clinical design based on participants with SCI, had main outcomes of restoration of bowel, bladder or sexual function and the intervention investigated was non-invasive neuromodulation. A total of 46 studies (combined sample of 1,801) were included in this systematic review, comprising studies of transcutaneous electrical nerve stimulation, magnetic stimulation and vibratory stimulation. Of the 46 studies, 7 were randomized controlled trials (RCTs), 36 were non-RCTs and 3 were case reports. Most studies (43/46) reported improvements in bowel (5/5), bladder (32/35) and sexual (6/6) dysfunction after SCI. However, the quality of the included studies was variable and associated with a high risk of bias. Thus, well-designed, blinded and sham-controlled RCTs with larger populations are required to establish clinical efficacy of these methods.

Clinical neurology and neurosurgery. 2020 Apr 12 [Epub ahead of print]

Sam Parittotokkaporn, Chris Varghese, Greg O'Grady, Darren Svirskis, Sureshbabu Subramanian, Simon J O'Carroll

Department of Anatomy and Medical Imaging, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Spinal Cord Injury Research Facility, The Centre for Brain Research, University of Auckland, Auckland, New Zealand. Electronic address: ., Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand., Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand., School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand., Auckland Spinal Rehabilitation Unit (ASRU), Manukau District Health Board, Auckland, New Zealand., Department of Anatomy and Medical Imaging, School of Medical Sciences, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Spinal Cord Injury Research Facility, The Centre for Brain Research, University of Auckland, Auckland, New Zealand.