Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Neurourol Urodyn. 2010 Mar;29(3):395-400. doi: 10.1002/nau.20770.
Conditional stimulation of dorsal genital nerves suppresses undesired detrusor contractions (UDC) and consequently increases bladder capacity and prevents incontinence. No clinically applicable sensor exists for reliable bladder activity monitoring as a trigger for conditional stimulation. Primary objective of this study was to determine whether bladder sensation concomitant with UDC may be used for spinal cord injury (SCI) patients to trigger neurostimulation in daily life.
Nineteen male and 7 female SCI patients suspected of detrusor overactivity (DO) underwent conventional and 6-hr ambulatory urodynamics. Patients were instructed to do normal daily activities and to activate event buttons of the ambulatory recorder to mark events: physical activity, bladder sensation, micturition or intermittent catheterization, and urinary incontinence. Detection rate was defined as the number of recorded bladder sensation divided by the total number of recorded UDC during ambulatory urodynamics.
Bladder sensation was reported by 73% of patients in daily life. Only 41% of patients had analyzable bladder sensation concomitant with UDC during ambulatory urodynamics. For ambulatory and conventional urodynamics, mean detection rates were 23% and 72%, respectively, with mean recording delays of 57 and 16 sec after UDC onset, respectively.
Bladder sensation only occurs in a small group of SCI patients combined with a rather low detection rate and long reaction time. Therefore, bladder sensation as a trigger for conditional stimulation does not seem to be suitable for SCI patients with DO. Reliable techniques for chronic bladder activity monitoring are a prerequisite for successful clinical application of conditional stimulation.
阴部背神经的条件刺激可抑制不想要的逼尿肌收缩（UDC），从而增加膀胱容量并防止失禁。目前还没有临床应用的传感器可用于可靠的膀胱活动监测，以作为条件刺激的触发因素。本研究的主要目的是确定是否可以使用与 UDC 同时发生的膀胱感觉来触发脊髓损伤（SCI）患者日常生活中的神经刺激。
19 名男性和 7 名女性疑似逼尿肌过度活动（DO）的 SCI 患者接受了常规和 6 小时的动态尿动力学检查。患者被指示进行正常的日常活动，并激活动态记录器的事件按钮以标记事件：体力活动、膀胱感觉、排尿或间歇性导尿以及尿失禁。检测率定义为记录的膀胱感觉次数除以动态尿动力学检查期间记录的 UDC 总数。
73%的患者在日常生活中报告了膀胱感觉。只有 41%的患者在动态尿动力学检查中出现了可分析的 UDC 同时伴有膀胱感觉。对于动态和常规尿动力学检查，平均检测率分别为 23%和 72%，UDC 发生后的平均记录延迟分别为 57 和 16 秒。
膀胱感觉仅发生在一小部分 SCI 患者中，并且检测率和反应时间都较低。因此，作为条件刺激触发因素的膀胱感觉似乎不适合患有 DO 的 SCI 患者。可靠的慢性膀胱活动监测技术是成功应用条件刺激的先决条件。
