Electrical Stimulation of the Pudendal Nerve Promotes Neuroregeneration and Functional Recovery from Stress Urinary Incontinence in a Rat Model

The pudendal nerve can be injured during vaginal delivery of children and slowed pudendal nerve regeneration has been correlated with development of stress urinary incontinence (SUI). Simultaneous injury to the pudendal nerve and its target muscle, the external urethral sphincter (EUS), during delivery likely leads to slowed neuroregeneration. The goal of this study was to determine if repeat electrical stimulation of the pudendal nerve improves SUI recovery and promotes neuroregeneration in a dual muscle and nerve injury rat model of SUI. Rats received electrical stimulation or sham stimulation of the pudendal nerve twice weekly for up to 2 weeks after injury. A separate cohort of rats received sham injury and sham stimulation. Expression of brain-derived neurotrophic factor (BDNF) and βII-tubulin expression in Onuf's nucleus was measured 2, 7, and 14 days after injury. Urodynamics, leak point pressure (LPP), and EUS electromyography (EMG) were recorded 14 days after injury. Electrical stimulation significantly increased expression of BDNF at all time points and βII-tubulin 1 and 2 weeks after injury. Two weeks after injury, LPP and EUS EMG during voiding and LPP testing were significantly decreased compared to sham injured animals. Electrical stimulation significantly increased EUS during voiding , although LPP did not fully recover. Repeat pudendal nerve stimulation promotes neuromuscular continence mechanism recovery possibly via a neuroregenerative response through BDNF upregulation in the pudendal motoneurons in this model of SUI. Electrical stimulation of the pudendal nerve may therefore improve recovery after childbirth and ameliorate symptoms of SUI by promoting neuroregeneration after injury.

American journal of physiology. Renal physiology. 2018 Aug 22 [Epub ahead of print]

Hai-Hong Jiang, Qi-Xiang Song, Bradley C Gill, Brian M Balog, Raul Juarez, Yolanda Cruz, Margot S Damaser

Department of Biomedical Engineering, Cleveland Clinic, United States., Department of Urology, Changhai Hospital., Department of Biomedical Engineering, Cleveland Clinic., Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala., Centro Tlaxcala de Biología de la Conducta, Universidad Autónoma de Tlaxcala, Mexico., Biomedical Engineering, Cleveland Clinic, United States.

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