Radziszewski Krzysztof, Zielinski Henryk, Radziszewski Pawel, Swiecicki Rafal
Clinic of Rehabilitation, Military Hospital, Bydgoszcz, Poland.
Int Urol Nephrol. 2009;41(3):497-503. doi: 10.1007/s11255-008-9488-7. Epub 2008 Nov 12.
The treatment of neurogenic dysfunctions of micturition, both surgical and conservative, aims primarily to protect upper urinary tract function. This goal can be achieved by lowering intravesical pressure and increasing urinary bladder capacity in the urine collection phase or by facilitating bladder emptying.
The objective of this paper was to assess the outcome of transcutaneous stimulation of the urinary bladder in the treatment of neurogenic disorders of micturition.
The effect of urinary bladder stimulation was assessed in 22 patients (4 females, 18 males) with spinal injuries (19 with injuries to the lumbo-sacral spine and 3 with cervical spine injuries) treated at the Department of Rehabilitation of the Military Hospital in Bydgoszcz, Poland, in 2006 and 2007. The treatment consisted of 30 procedures of transcutaneous electrical stimulation of the urinary bladder. A pulsed sinusoid current was used with a pulse duration of 200 ms, break duration of 1,000 ms, intensity of 15-20 mA, frequency of 50 Hz, and duration of stimulation of 15 min. A urodynamic study was carried out in each patient at baseline and on completion of the electrical stimulation therapy (immediately and after 2 months).
Electrical stimulation of the neurogenic urinary bladder produced increases in the cystometric bladder capacity and reduction in the amount of residual urine (72% of patients), with reduction of intravesical pressure at peak urine flow (59% of the patients). The dynamic aspects of micturition also improved with increased peak voiding velocity in 77.3% of the patients. More than half of the patients (57%) still had elevated intravesical pressures during micturition that posed a risk to the function of the upper urinary tract despite significant decreases following the stimulation therapy. Micturition, which was absent at baseline, was restored in three patients. No local complications were observed.
Transcutaneous electrical stimulation of the urinary bladder in patients with neurogenic bladder dysfunction improves lower urinary tract function. Urodynamic studies executed 2 months after finishing TES show persistent results.
排尿神经功能障碍的治疗，无论是手术治疗还是保守治疗，主要目的是保护上尿路功能。这一目标可以通过在尿液收集阶段降低膀胱内压和增加膀胱容量，或通过促进膀胱排空来实现。
本文的目的是评估经皮膀胱刺激治疗排尿神经功能障碍的效果。
2006年和2007年在波兰比得哥什军事医院康复科对22例脊髓损伤患者（4例女性，18例男性）进行了膀胱刺激效果评估，其中19例为腰骶部脊柱损伤，3例为颈椎损伤。治疗包括30次经皮膀胱电刺激。使用脉冲正弦电流，脉冲持续时间为200毫秒，间歇持续时间为1000毫秒，强度为15 - 20毫安，频率为50赫兹，刺激持续时间为15分钟。在基线时以及电刺激治疗完成时（立即和2个月后）对每位患者进行尿动力学研究。
神经源性膀胱的电刺激使膀胱测压容量增加，残余尿量减少（72%的患者），尿流峰值时膀胱内压降低（59%的患者）。排尿的动力学方面也有所改善，77.3%的患者排尿峰值流速增加。超过一半的患者（57%）在排尿时膀胱内压仍然升高，尽管刺激治疗后显著降低，但仍对上尿路功能构成风险。3例基线时无排尿的患者恢复了排尿。未观察到局部并发症。
经皮电刺激神经源性膀胱功能障碍患者可改善下尿路功能。完成经皮电刺激治疗2个月后进行的尿动力学研究显示效果持续。
