Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Urology, Kangwon National University School of Medicine, Chuncheon, South Korea.
Neuromodulation. 2019 Aug;22(6):697-702. doi: 10.1111/ner.12895. Epub 2018 Dec 2.
Incomplete spinal cord injury (SCI) accounts for two-thirds of all SCIs in clinical practice. Preclinical research on the effect of sacral neuromodulation (SNM) on bladder function, however, has been focused only on animal models of complete SCI. We aimed to evaluate the effect of early SNM on bladder responses in a rat model of incomplete SCI.
Altogether, 21 female Sprague-Dawley rats were equally assigned to control (CTR), SCI + sham stimulation (SHAM), and SCI + SNM (SNM) groups. In the SHAM and SNM groups, incomplete SCI was created by producing a moderate contusion with an NYU-MASCIS impactor at the T9-T10 level of the spine, with needle electrodes implanted bilaterally into the S2 or S3 sacral foramen. Only SNM group underwent electrical stimulation for 28 days, beginning on day 7 after SCI. Cystometry was performed 35 days after SCI.
Although the interval between voiding contractions was significantly longer in the SHAM group than the CTR group (25.5 ± 1.4 vs. 12.5 ± 1.7 min; p < 0.05), there were no significant differences between the SNM group (16.5 ± 1.5 min) and the CTR group. Maximum voiding contraction pressure did not differ among the groups. The SNM group had a significantly lower frequency (3.5 ± 0.5 vs. 14.6 ± 2.0; p < 0.05) and maximum pressure (11.4 ± 6.2 vs. 21.3 ± 1.8 cmH O; p < 0.05) of nonvoiding contractions than the SHAM group.
Our results provide experimental evidence that early SNM treatment may prevent or diminish bladder dysfunctions (e.g., detrusor overactivity, abnormal micturition reflex) in a clinical condition of incomplete SCI.
不完全性脊髓损伤（SCI）占临床 SCI 的三分之二。然而，针对骶神经调节（SNM）对膀胱功能影响的临床前研究仅集中在完全性 SCI 的动物模型上。我们旨在评估早期 SNM 对不完全性 SCI 大鼠模型膀胱反应的影响。
共 21 只雌性 Sprague-Dawley 大鼠平均分为对照组（CTR）、SCI+假刺激组（SHAM）和 SCI+SNM 组（SNM）。在 SHAM 和 SNM 组中，通过在脊柱 T9-T10 水平使用 NYU-MASCIS 撞击器产生中度挫伤，并将针电极双侧植入 S2 或 S3 骶孔来建立不完全性 SCI。仅对 SNM 组进行电刺激，从 SCI 后第 7 天开始，共 28 天。在 SCI 后 35 天进行膀胱测压。
尽管与 CTR 组相比，SHAM 组排尿间隔明显延长（25.5±1.4 分钟比 12.5±1.7 分钟；p<0.05），但与 SNM 组（16.5±1.5 分钟）相比，差异无统计学意义。最大排尿收缩压在各组间无差异。SNM 组的非排尿收缩频率（3.5±0.5 次/分比 14.6±2.0 次/分；p<0.05）和最大压力（11.4±6.2 厘米水柱比 21.3±1.8 厘米水柱；p<0.05）明显低于 SHAM 组。
我们的结果提供了实验证据，表明早期 SNM 治疗可能预防或减轻不完全性 SCI 临床情况下的膀胱功能障碍（例如逼尿肌过度活动、异常排尿反射）。
