In this study, 7 subjects were included with stable spinal cord injuries T11 or above that has been present for > 1 year. The injuries ranged from thoracic to cervical levels and the injuries carried from ASIA A to C. All the patients performed clean intermittent catheterization.
The test period was over two days. Spinal cord mapping was completed on day one and dose-response curves of the external and internal sphincter were taken. Stimulation varied in intensity (10 mA – 200 mA). He found that T11 and L1 had the best responses.
Urodynamics was completed on day 2 at the setting that produced a maximum physiologic response.
Here are his results: To assess the effect on urine voiding, the bladder was filled to 80% urodynamic capacity and TSCS delivered at 1 Hz. As a result, voiding efficiency increased from 26.99 ± 15.41 to 50.80 ± 5.25 % (P < 0.05,n = 7). In addition, increased flow rate, decreased detrusor-sphincter dyssynergia and post-void residuals were noted. See the image below looking at a comparison of stimulation that is on and off. To assess the effect on urine storage, TSCS at 30 Hz was delivered during urodynamic bladder filling. As a result, bladder capacity increased from 170.54 ± 15.86 to 252.59 ± 18.91 ml (P < 0.05,n = 7). When UDS was repeated without stimulation, reversal to baseline was observed.
Looking into the future, this showed that stimulation can modulate the lower urinary tract function in spinal cord injury patients! Differing frequency and parameters can affect the degree. Other questions to as for future application are: long term use? Other functions?
Home use? More studies are needed for future application.
Funding: International Foundation for Research in Paraplegia
Presented by: Evgeniy I. Kreydin, MD, University of Southern California, Rancho Los Amigos National Rehabilitation Center
Written by: M Lira Chowdhury, DO, Fellow, Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, The University of California Irvine, Department of Urology, @lirachowdhury at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida