Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Am J Physiol Regul Integr Comp Physiol. 2021 May 1;320(5):R675-R682. doi: 10.1152/ajpregu.00346.2020. Epub 2021 Mar 10.
The purpose of this study is to determine whether superficial peroneal nerve stimulation (SPNS) can reverse persistent bladder underactivity induced by prolonged pudendal nerve stimulation (PNS). In 16 α-chloralose-anesthetized cats, PNS and SPNS were applied by nerve cuff electrodes. Skin surface electrodes were also used for SPNS. Bladder underactivity consisting of a significant increase in bladder capacity to 157.8 ± 10.9% of control and a significant reduction in bladder contraction amplitude to 56.0 ± 5.0% of control was induced by repetitive (4-16 times) application of 30-min PNS. SPNS (1 Hz, 0.2 ms) at 1.5-2 times threshold intensity (T) for inducing posterior thigh muscle contractions was applied either continuously (SPNSc) or intermittently (SPNSi) during a cystometrogram (CMG) to determine whether the stimulation can reverse the PNS-induced bladder underactivity. SPNSc or SPNSi applied by nerve cuff electrodes during the prolonged PNS inhibition significantly reduced bladder capacity to 124.4 ± 10.7% and 132.4 ± 14.2% of control, respectively, and increased contraction amplitude to 85.3 ± 6.2% and 75.8 ± 4.7%, respectively. Transcutaneous SPNSc and SPNSi also significantly reduced bladder capacity and increased contraction amplitude. Additional PNS applied during the bladder underactivity further increased bladder capacity, whereas SPNSc applied simultaneously with the PNS reversed the increase in bladder capacity. This study indicates that a noninvasive superficial peroneal neuromodulation therapy might be developed to treat bladder underactivity caused by abnormal pudendal nerve somatic afferent activation that is hypothesized to occur in patients with Fowler's syndrome.
本研究旨在确定浅表腓浅神经刺激（SPNS）是否可以逆转因长期阴部神经刺激（PNS）而引起的持续性膀胱活动不足。在 16 只α-氯醛麻醉的猫中，使用神经袖带电极施加 PNS 和 SPNS。还使用皮肤表面电极进行 SPNS。通过重复（4-16 次）施加 30 分钟的 PNS，引起膀胱活动不足，表现为膀胱容量显著增加至对照的 157.8 ± 10.9％，膀胱收缩幅度显著降低至对照的 56.0 ± 5.0％。应用 1.5-2 倍阈值强度（T）的 1 Hz、0.2 ms 的 SPNS（用于诱导后大腿肌肉收缩），无论是连续（SPNSc）还是间歇（SPNSi），在膀胱测压图（CMG）期间施加，以确定刺激是否可以逆转 PNS 引起的膀胱活动不足。在长时间 PNS 抑制期间，通过神经袖带电极施加的 SPNSc 或 SPNSi 分别将膀胱容量显著降低至对照的 124.4 ± 10.7％和 132.4 ± 14.2％，并将收缩幅度分别增加至对照的 85.3 ± 6.2％和 75.8 ± 4.7％。经皮 SPNSc 和 SPNSi 也显著降低了膀胱容量并增加了收缩幅度。在膀胱活动不足期间施加额外的 PNS 进一步增加了膀胱容量，而同时施加 SPNSc 则逆转了膀胱容量的增加。这项研究表明，非侵入性的浅表腓浅神经调节疗法可能被开发用于治疗由阴部神经躯体传入激活异常引起的膀胱活动不足，假设该异常发生在 Fowler 综合征患者中。
