Bycroft J A, Craggs M D, Sheriff M, Knight S, Shah P J R
Spinal Injuries Unit, Stanmore, Middlesex, United Kingdom.
Neurourol Urodyn. 2004;23(3):241-5. doi: 10.1002/nau.20009.
The aim of this study was to resolve the paradox as to whether magnetic stimulation of sacral nerve roots results in contraction or suppression of the bladder, in both normal individuals and patients with spinal cord injury (SCI).
Seven males with complete SCI and neurogenic detrusor overactivity (NDO) and five normal males were investigated. Bladder capacity and maximum cystometric capacity were determined, respectively, in these groups. Magnetic stimulation was applied to sacral nerve roots using a multi-pulse magnetic stimulator and coil. Stimulation was applied at half capacity, near-full capacity, and during NDO or voiding (in normal individuals). Single and intermittent bursts of stimulation were applied.
Neither single nor intermittent bursts of magnetic stimulation of the sacral nerve roots resulted in significant bladder pressure rises. Occasionally, following cessation of the magnetic stimulation bladder contractions were seen in patients with NDO. These contractions had an unpredictable and variable latency. As previously reported, magnetic stimulation suppressed NDO in patients with SCI, and suppressed voiding in normal individuals.
Bladder contractions are occasionally observed in patients with NDO following withdrawal of stimulation. This phenomenon hypothetically arises as a result of removal of the bladder suppression provided by magnetic stimulation, rather than direct motor pathway stimulation (as has been reported by others). The ability of sacral magnetic stimulation to suppress detrusor contractions is reaffirmed.
本研究旨在解决一个矛盾问题，即对于正常个体和脊髓损伤（SCI）患者，骶神经根的磁刺激究竟会导致膀胱收缩还是抑制膀胱功能。
对7名患有完全性SCI且伴有神经源性逼尿肌过度活动（NDO）的男性患者以及5名正常男性进行了研究。分别测定了这些组的膀胱容量和最大膀胱测压容量。使用多脉冲磁刺激器和线圈对骶神经根进行磁刺激。在半容量、接近全容量时以及在NDO期间或排尿时（正常个体）施加刺激。施加了单次和间歇性刺激脉冲串。
对骶神经根进行单次或间歇性磁刺激均未导致膀胱压力显著升高。偶尔，在NDO患者中，磁刺激停止后会出现膀胱收缩。这些收缩具有不可预测且变化的潜伏期。如先前报道，磁刺激可抑制SCI患者的NDO，并抑制正常个体的排尿。
在刺激停止后，NDO患者偶尔会观察到膀胱收缩。这种现象假设是由于磁刺激提供的膀胱抑制作用被消除，而非直接的运动通路刺激（正如其他人所报道的那样）所致。再次证实了骶部磁刺激抑制逼尿肌收缩的能力。
