Shi Ping, Fang Youfang, Yu Hongliu
Institute of Rehabilitation Engineering and Technology - University of Shanghai for Science and Technology, Shanghai, China.
Int Braz J Urol. 2015 Nov-Dec;41(6):1194-201. doi: 10.1590/S1677-5538.IBJU.2014.0144.
Compared to conventional therapies, sacral neuromodulation (SNM) may offer an alternative, non-destructive treatment for SCI patients with bladder dysfunction. Understanding bladder response to SNM treatment for SCI in different phases may yield new insights for innovative use of this promising technique.
Female Sprague-Dawley rats were used in this study to examine the effects of acute SNM on bladder reflex in complete SCI rats. All rats were anesthetized and set up for continuous saline infusion. Acute SNM treatment was implemented for about 6 hours for each rat. Cystometric parameters, including time between contractions, contraction duration, bladder peak pressure, and number of uninhibited contractions, were analyzed and compared within rats before and after SNM treatment.
For the spinally transected rats during early phase (less than two weeks post spinalization), the time between contractions and contraction duration both increased after SNM treatments, yet the increased amplitude was about or less than 20%. For the spinally transected rats with a longer days survival (about two to four weeks post spinalization), the time between contractions and contraction duration substantially increased after SNM treatment and the changes for their average values were more than 90%. For the spinally transected rats with a much longer days survival (more than five weeks post spinalization), the time between contractions and contraction duration increased after SNM treatments, yet the magnitude of changes were less than 30%.
The present study suggested that the significant effectiveness of SNM for complete SCI played its role after the spinal shock phase and prior to the development of detrusor overactivity. It indicated that the time point of SNM treatment is necessary to be paid attention.
与传统疗法相比，骶神经调节（SNM）可能为患有膀胱功能障碍的脊髓损伤（SCI）患者提供一种替代性的、非破坏性的治疗方法。了解膀胱在不同阶段对SNM治疗SCI的反应，可能会为这项有前景的技术的创新应用带来新的见解。
本研究使用雌性Sprague-Dawley大鼠，以检查急性SNM对完全性SCI大鼠膀胱反射的影响。所有大鼠均麻醉并设置为持续输注生理盐水。对每只大鼠进行约6小时的急性SNM治疗。分析并比较大鼠在SNM治疗前后的膀胱测压参数，包括收缩间隔时间、收缩持续时间、膀胱峰值压力和无抑制收缩次数。
对于脊髓横断早期（脊髓损伤后不到两周）的大鼠，SNM治疗后收缩间隔时间和收缩持续时间均增加，但增加幅度约为20%或小于20%。对于存活时间较长（脊髓损伤后约两到四周）的脊髓横断大鼠，SNM治疗后收缩间隔时间和收缩持续时间大幅增加，其平均值变化超过90%。对于存活时间更长（脊髓损伤后超过五周）的脊髓横断大鼠，SNM治疗后收缩间隔时间和收缩持续时间增加，但变化幅度小于30%。
本研究表明，SNM对完全性SCI的显著有效性在脊髓休克期后、逼尿肌过度活动发展之前发挥作用。这表明SNM治疗的时间点需要引起注意。
