Kirkham A P, Shah N C, Knight S L, Shah P J, Craggs M D
Neuroprostheses Research Centre, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK.
Spinal Cord. 2001 Aug;39(8):420-8. doi: 10.1038/sj.sc.3101177.
Laboratory investigation using serial slow-fill cystometrograms.
To examine the acute effects of different modes of dorsal penile nerve stimulation on detrusor hyperreflexia, bladder capacity and bladder compliance in spinal cord injury (SCI).
Spinal Injuries Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
Fourteen SCI patients were examined. Microtip transducer catheters enabled continuous measurement of anal sphincter, urethral sphincter and intravesical pressures. Control cystometrograms were followed by stimulation of the dorsal penile nerve at 15 Hz, 200 micros pulse width and amplitude equal to twice that which produced a pudendo-anal reflex. Stimulation was either continuous or in bursts of one minute triggered by a rise in detrusor pressure of 10 cm water (conditional). Further control cystometrograms were then performed to examine the residual effects of stimulation.
Bladder capacity increased significantly during three initial control fills. Continuous stimulation (n=6) significantly increased bladder capacity by a mean of 110% (+/-Standard Deviation 85%) or 173 ml (+/-146 ml), and bladder compliance by a mean of 53% (+/-31%). Conditional stimulation in a different group of patients (n=6) significantly increased bladder capacity, by 144% (+/-127%) or 230 ml (+/-143 ml). In the conditional neuromodulation experiments, the gap between suppressed contractions fell reliably as bladder volume increased, and the time from start of stimulation to peak of intravesical pressure and 50% decline in intravesical pressure rise was 2.8 s (+/-0.9 s) and 7.6 s (+/-1.0s) respectively. The two methods of stimulation were compared in six patients; in four out of six conditional neuromodulation resulted in a higher mean bladder capacity than continuous, but the difference was not significant.
Both conditional and continuous stimulation significantly increase bladder capacity. The conditional mode is probably at least as effective as the continuous, suggesting that it could be used in an implanted device for bladder suppression.
采用连续慢速充盈膀胱测压图的实验室研究。
研究不同模式的阴茎背神经刺激对脊髓损伤（SCI）患者逼尿肌反射亢进、膀胱容量和膀胱顺应性的急性影响。
英国米德尔塞克斯郡斯坦莫尔皇家国立骨科医院脊髓损伤科。
对14例脊髓损伤患者进行检查。微尖端换能器导管可连续测量肛门括约肌、尿道括约肌和膀胱内压力。在进行对照膀胱测压图后，以15赫兹、200微秒脉冲宽度和等于产生阴部-肛门反射两倍的幅度刺激阴茎背神经。刺激方式为连续刺激或当逼尿肌压力升高10厘米水柱时触发的1分钟脉冲刺激（条件性刺激）。然后进行进一步的对照膀胱测压图，以检查刺激的残余效应。
在最初的三次对照充盈过程中，膀胱容量显著增加。连续刺激（n = 6）使膀胱容量平均显著增加110%（±标准差85%）或173毫升（±146毫升），膀胱顺应性平均增加53%（±31%）。另一组患者（n = 6）的条件性刺激使膀胱容量显著增加144%（±127%）或230毫升（±143毫升）。在条件性神经调节实验中，随着膀胱容量增加，抑制性收缩之间的间隔可靠地缩短，从刺激开始到膀胱内压力峰值以及膀胱内压力上升下降50%的时间分别为2.8秒（±0.9秒）和7.6秒（±1.0秒）。在6例患者中对两种刺激方法进行了比较；6例中有4例条件性神经调节导致的平均膀胱容量高于连续刺激，但差异不显著。
条件性刺激和连续刺激均能显著增加膀胱容量。条件性刺激模式可能至少与连续刺激一样有效，这表明它可用于植入式膀胱抑制装置。
