AUA 2019: Transcutaneous Spinal Cord Stimulation to Effect Lower Urinary Tract Activity after Spinal Cord Injury

Chicago, IL (UroToday.com) This moderated poster session focused on new methods to evaluate or treat those patients neurogenic bladders. Patients with spinal cord injuries, in particular, have a large requirement for urological care, and a large spectrum of neurogenic voiding dysfunction. Questions still remain about what can be done in the acute or chronic phases of spinal cord injury to improve longevity and quality of life, and more specifically what can be done to facilitate bladder emptying or safer storage pressures. Taking a cue from our colleagues in physical medicine and rehabilitation, these authors were curious if they could demonstrate changes in bladder activity via transcutaneous spinal cord stimulation (TSCS), similar to what had previously been described to improve upper and lower extremity function.

In their study design they included 7 patients (3 male and 4 female) with a spinal cord injury of >1 year old (range of 1-23 years) at or above T11 (range of C3 to T11; ASIA A (n=4), B (n=1), C (n=2)), whose bladder emptying were managed with clean intermittent catheterization. Each patient underwent two separate days of treatment and testing. On both days patients received TSCS while their lower urinary tract was being evaluated. The TSCS during these examinations had variation in location (T11-L1) and intensity (10-200mAmps). Day 1 was focused on establishing the appropriate dose (location and intensity) for each patient via evaluation of the activation of the detrusor and external urethral sphincter. Day 2 then had each patient undergo baseline urodynamics followed by repeat urodynamics utilizing the maximum physiologic response setting as established on Day 1. Data from the bladder storage and emptying portions from each of the UDS were collected and analyzed. During the filling phases of testing, TSCS was applied at 30Hz. During voiding, it was applied at 1Hz, and the patient’s bladder was filled to 80% of previously urodynamic estimated bladder capacity.

In regards to bladder capacity in these 7 patients, they appreciated an increase in volume with TSCS use 7 patients (without TSCS: 170.54ml +/- 15.86; TSCS 252.59ml +/-18.91; P<0.05). Similarly voiding efficiency, measured as a percent voided of the bladder volume, also improved with TSCS (without TSCS 26.99% +/- 15.41; TSCS 50.8% +/-5.25; P<0.05). They also reported a decreased incidence of detrusor-sphincter dyssynergia, increased flow rates, and lower post-void residual volumes with TSCS. The authors concluded that this is the first demonstration on change in measured lower urinary tract function via TSCS.

As the authors point out, what perhaps is the most interesting portions of this study is not only that they were able to change bladder storage and emptying in patients with SCI, but could do so to varying degrees by changing the TSCS parameters. The implications of having a personalized and adjustable treatment option for patients with SCI that could facilitate bladder storage and emptying are quite fantastic, and could translate into improved quality of life by decreasing the frequency that CIC needs to be performed, or simply be an alternative or adjunct to other medical or surgical means to improve storage volumes in neurogenic bladders. The authors intend to further evaluate long-term stimulation, applications in bowel or erectile function, and if this treatment could be administered at home.


Presented by: Evgeniy Kreydin, MD, Institute of Urology, University of Southern California and Rancho Los Amigos National Rehabilitation Center, Los Angeles, California

Written by: Ross Moskowitz, MD; Assistant Clinical Professor of Urology, University of California Irvine Medical Center; @rossmosk1 at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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