Department of Clinical Fundamentals of Physiotherapy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Warsaw, Poland.
NeuroRehabilitation. 2013;32(4):867-73. doi: 10.3233/NRE-130911.
The complications of neurogenic dysfunction of the urinary bladder still constitute an important cause of death among spinal cord injury patients.
The aim of this study was to assess transcutaneous electrical stimulation of the urinary bladder as a treatment for micturition disorders in patients after spinal cord injury (SCI) over 2 years of follow-up.
The study involved 28 patients (22 men and 6 women) with neurogenic bladder dysfunction following a spinal cord injury. The patients were 16 to 68 years old and 2 to 26 months since their spinal cord injury. The therapeutic programme involved 30 sessions of electrical stimulation of the urinary bladder, five sessions per week. The outcomes of electrical stimulation were assessed by comparing the results of urodynamic examinations performed before treatment, immediately on completion of the treatment and at 24 months post-treatment.
Transcutaneous electrical stimulation of the urinary bladder produced a significant increase in bladder capacity (p = 0.001), which was higher by a mean of 117.7 ml immediately on completion of the treatment and a mean of 101.6 ml (p = 0.018) two years after the treatment. The amount of post-void residual urine in the bladder decreased by a mean of 81.9 ml (p = 0.007) immediately after completion of the treatment and a mean of 76.9 ml (p = 0.011) two years after the treatment. Opening pressure was lower by a mean of 3.1 cm H₂O (p > 0.05) immediately on completion of the electrical stimulation treatment. Intravesical pressure at maximum flow decreased in 19 patients (68%) by a mean of 11.6 cm H₂O (p > 0.05). At the late follow-up assessment, opening pressure was lower in 17 patients (68%) by a mean of 6.7 cm H₂O. Two patients demonstrated the micturition phase, which had been absent at baseline and immediately after completion of the treatment. Opening pressure in the entire group was lower compared to baseline by 2.9 cm H₂O (p > 0.05). Also in the late follow-up assessment, intravesical pressure at maximum flow was reduced in 21 patients (79%) by a mean of 9.6 cm H₂O (p > 0.05). The maximum voiding velocity increased by a mean of 3.8 ml/s (p = 0.008) immediately after treatment completion and by a mean of 3.6 ml/s (p < 0.001) at two years post-treatment.
Transcutaneous electrical stimulation of the neurogenic bladder in patients following spinal cord injury improves lower urinary tract function. Improved urinary tract function is seen two years following completion of the electrical stimulation treatment.
神经源性膀胱功能障碍的并发症仍然是脊髓损伤患者死亡的一个重要原因。
本研究旨在评估经皮电刺激膀胱作为脊髓损伤（SCI）后患者排尿障碍的治疗方法，随访时间超过 2 年。
研究纳入 28 例（22 名男性和 6 名女性）因脊髓损伤而出现神经源性膀胱功能障碍的患者。患者年龄 16 至 68 岁，脊髓损伤后 2 至 26 个月。治疗方案包括 30 次膀胱电刺激，每周 5 次。通过比较治疗前、治疗完成时和治疗后 24 个月的尿动力学检查结果来评估电刺激的效果。
经皮电刺激膀胱可显著增加膀胱容量（p = 0.001），治疗完成时平均增加 117.7ml，治疗后 2 年平均增加 101.6ml（p = 0.018）。膀胱残余尿量平均减少 81.9ml（p = 0.007），治疗完成时和治疗后 2 年分别平均减少 76.9ml（p = 0.011）。在治疗完成时，膀胱内压最大流量下降 3.1cmH₂O（p > 0.05）。19 名患者（68%）的最大膀胱内压在最大流量时下降 11.6cmH₂O（p > 0.05）。在晚期随访评估中，17 名患者（68%）的膀胱内压下降 6.7cmH₂O。两名患者出现了排尿期，这在基线和治疗完成时都不存在。与基线相比，整个组的膀胱内压下降 2.9cmH₂O（p > 0.05）。在晚期随访评估中，21 名患者（79%）的最大膀胱内压在最大流量时下降 9.6cmH₂O（p > 0.05）。最大排空速度平均增加 3.8ml/s（p = 0.008），治疗完成时增加，治疗后 2 年增加 3.6ml/s（p < 0.001）。
经皮电刺激脊髓损伤后患者的神经源性膀胱可改善下尿路功能。在电刺激治疗完成后两年仍可观察到改善的尿路功能。
