Theisen Katherine, Browning Jeffery, Li Xing, Li Shun, Shen Bing, Wang Jicheng, Roppolo James R, de Groat William C, Tai Changfeng
Department of Urology, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Urology, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University, Beijing, P.R. China.
Neuromodulation. 2018 Oct;21(7):700-706. doi: 10.1111/ner.12792. Epub 2018 Jun 27.
This study is aimed at determining if tibial nerve stimulation (TNS) can modulate both bladder underactivity and overactivity.
In α-chloralose anesthetized cats, tripolar cuff electrodes were implanted on both tibial nerves and TNS threshold (T) for inducing toe twitching was determined for each nerve. Normal bladder activity was elicited by slow intravesical infusion of saline; while bladder overactivity was induced by infusion of 0.25% acetic acid to irritate the bladder. Bladder underactivity was induced during saline infusion by repeated application (2-6 times) of 30-min TNS (5 Hz, 4-8T, 0.2 msec) to the left tibial nerve, while TNS (1 Hz, 4T, 0.2 msec) was applied to the right tibial nerve to reverse the bladder underactivity.
Prolonged 5-Hz TNS induced bladder underactivity by significantly increasing bladder capacity to 173.8% ± 10.4% of control and reducing the contraction amplitude to 40.1% ± 15.3% of control, while 1 Hz TNS normalized the contraction amplitude and significantly reduced the bladder capacity to 130%-140% of control. TNS at 1 Hz in normal bladders did not change contraction amplitude and only slightly changed the capacity, but in both normal and underactive bladders significantly increased contraction duration. The effects of 1 Hz TNS did not persist following stimulation. Under isovolumetric conditions when the bladder was underactive, TNS (0.5-3 Hz; 1-4T) induced large amplitude and sustained bladder contractions. In overactive bladders, TNS during cystometry inhibited bladder overactivity at 5 Hz but not at 1 Hz.
This study indicates that TNS at different frequencies might be used to treat bladder underactivity and overactivity.
本研究旨在确定胫神经刺激（TNS）是否能调节膀胱活动低下和活动过度。
在α-氯醛糖麻醉的猫身上，将三极袖带电极植入双侧胫神经，并确定每条神经诱发足趾抽搐的TNS阈值（T）。通过膀胱内缓慢输注生理盐水诱发正常膀胱活动；通过输注0.25%乙酸刺激膀胱诱发膀胱活动过度。在生理盐水输注期间，通过对左侧胫神经重复施加（2 - 6次）30分钟的TNS（5赫兹，4 - 8T，0.2毫秒）诱发膀胱活动低下，而对右侧胫神经施加TNS（1赫兹，4T，0.2毫秒）以逆转膀胱活动低下。
持续的5赫兹TNS通过将膀胱容量显著增加至对照值的173.8%±10.4%并将收缩幅度降低至对照值的40.1%±15.3%诱发膀胱活动低下，而1赫兹TNS使收缩幅度恢复正常并将膀胱容量显著降低至对照值的130% - 140%。正常膀胱中1赫兹的TNS未改变收缩幅度，仅轻微改变容量，但在正常和活动低下的膀胱中均显著增加收缩持续时间。1赫兹TNS的作用在刺激后不持续。在膀胱活动低下的等容条件下，TNS（0.5 - 3赫兹；1 - 4T）诱发大幅度且持续的膀胱收缩。在膀胱活动过度的情况下，膀胱测压期间的TNS在频率为5赫兹时抑制膀胱活动过度，但在1赫兹时无此作用。
本研究表明不同频率的TNS可能用于治疗膀胱活动低下和活动过度。
