Su Xin, Nickles Angela, Nelson Dwight E
Medtronic, Inc., Neuromodulation Research, Minneapolis, Minnesota.
Neurourol Urodyn. 2015 Jan;34(1):92-7. doi: 10.1002/nau.22506. Epub 2013 Oct 22.
To determine time course of the bladder inhibitory response to unilateral or bilateral stimulation of the tibial nerve (TN) and spinal nerve (SN) as well as the interaction of stimulation at these two sites.
In anesthetized female rats, a wire electrode was placed under either one or both of the TN or L6 SN. A cannula was placed into the bladder via the urethra. Saline infusion induced bladder rhythmic contraction (BRC).
Compared to SN neuromodulation, TN neuromodulation is less efficacious. The first 5-min stimulation at three times motor threshold on the SN and TN decreased the BRC frequency to 9% and 69% of controls, respectively. In contrast to SN stimulation, bilateral TN neuromodulation is not more effective than unilateral and sustained TN stimulation results in an apparent desensitization of the bladder response. If a 15-min TN stimulation was applied, BRCs were shutdown only during the first 5 min of stimulation. If a 5-min stimulation, using sufficient current to abolish BRC, is repeated, at least 20 min between stimulations was required in order for the responses to the first and second stimulations to be equivalent. Finally, stimulation of the TN combined with SN never produced a significantly greater effect than TN or SN stimulation alone.
Based on the current experiments, it would appear that SN neuromodulation of bladder activity is preferable to TN stimulation and there is no evidence to suggest that stimulation at both sites would offer a therapeutic advantage over spinal stimulation alone.
确定膀胱对单侧或双侧胫神经（TN）和脊神经（SN）刺激的抑制反应的时间进程，以及这两个部位刺激之间的相互作用。
在麻醉的雌性大鼠中，将线电极置于TN或L6 SN的一侧或两侧下方。通过尿道将套管插入膀胱。盐水灌注诱导膀胱节律性收缩（BRC）。
与SN神经调节相比，TN神经调节效果较差。在SN和TN上以三倍运动阈值进行的前5分钟刺激分别将BRC频率降低至对照的9%和69%。与SN刺激不同，双侧TN神经调节并不比单侧更有效，持续的TN刺激会导致膀胱反应明显脱敏。如果施加15分钟的TN刺激，BRC仅在刺激的前5分钟内停止。如果重复使用足以消除BRC的电流进行5分钟刺激，则两次刺激之间至少需要20分钟才能使对第一次和第二次刺激的反应等效。最后，TN与SN联合刺激产生的效果从未比单独的TN或SN刺激显著更大。
基于当前实验，似乎膀胱活动的SN神经调节优于TN刺激，并且没有证据表明在两个部位进行刺激比单独的脊髓刺激具有治疗优势。
