Wenzler David L, Burks Frank N, Cooney Maureen, Peters Kenneth M
Department of Urology, Beaumont Health System, Royal Oak, MI, USA.
Neuromodulation. 2015 Apr;18(3):228-31; discussion 232. doi: 10.1111/ner.12213. Epub 2014 Aug 12.
Sacral neuromodulation (SNM) is theorized to alter the neural pathways that mediate bladder and urethral sensation. We hypothesize that SNM affects current perception thresholds (CPTs) of afferent sensory nerve pathways.
Eight women were enrolled and completed pre and postoperative testing. A CPT device was used to measure CPT at 5 Hz (C-fibers), 250 Hz (Aδ-fibers), and 2000 Hz (Aβ-fibers) on the urethra and bladder prior to and one month after SNM. Index finger readings at 2000 Hz served as controls.
SNM had the greatest effect on the bladder at 250 and 2000 Hz, suggesting reduced bladder sensitivity. Significant changes in CPT were seen in the bladder at 2000 Hz with a decrease in sensitivity (p = 0.033). CPT testing was well tolerated, and no adverse events were identified.
With a measurable change in CPT values for Aδ-fibers and Aβ-fibers, these findings suggest that SNM modulates large myelinated afferent fibers in the bladder. Notably, little or no changes were found in the C-fiber CPT measurements. More research is needed with a larger sample size to determine the significance of these findings.
骶神经调节（SNM）理论上可改变介导膀胱和尿道感觉的神经通路。我们假设SNM会影响传入感觉神经通路的电流感知阈值（CPT）。
招募8名女性并完成术前和术后测试。使用CPT设备在SNM术前和术后1个月测量尿道和膀胱在5Hz（C纤维）、250Hz（Aδ纤维）和2000Hz（Aβ纤维）时的CPT。以2000Hz时食指的读数作为对照。
SNM在250Hz和2000Hz时对膀胱的影响最大，表明膀胱敏感性降低。在2000Hz时膀胱的CPT有显著变化，敏感性降低（p = 0.033）。CPT测试耐受性良好，未发现不良事件。
Aδ纤维和Aβ纤维的CPT值有可测量的变化，这些发现表明SNM调节膀胱中的大髓鞘传入纤维。值得注意的是，C纤维CPT测量中几乎没有发现变化。需要更大样本量的更多研究来确定这些发现的意义。
