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Turner K, O'Connell PR, Jones JFX. The projection of anorectal afferents to spinal cord and effect of sacral neuromodulation on dorsal horn neurons which receive such input in the rat. Neurogastroenterol Motil 2019; 31:e13536. [PMID: 30667128 DOI: 10.1111/nmo.13536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The rat has served usefully as a model for fecal incontinence and exploration of the mechanism of action of sacral neuromodulation (SNM). There remains a deficit in information regarding the location and type of spinal neurons which receive anorectal input and the effect of SNM on those neurons. METHODS Single neuronal extracellular recordings of neurons receiving anorectal input were made at the S1 level of the spinal cord using sharp glass electrodes. SNM at S1 was delivered at 2 Hz for 3 minutes and its effect on discharge was quantified. KEY RESULTS In total, 31 units (n = 14 animals) receiving anorectal synaptic input were recorded at the first sacral (S1) segmental level in either lamina III or IV of the dorsal horn. The inputs were classified according to afferent fiber conduction speed (16 Aδ, 11 Aβ, and 4 C-fiber). The baseline firing frequency (ie, the mean firing frequency before the application of SNM) was 0.48 Hz ± 0.49 (mean ± SD) and 58% of units responded to acute SNM with either an increase or decrease in mean firing frequency. CONCLUSIONS & INFERENCES In this study, the majority of spinal neurons receiving anorectal input changed their activity in response to SNM. These findings provide the basis for future studies which aim to explore the precise cellular mechanism of action of SNM on this fecal continence pathway.
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Affiliation(s)
- Keira Turner
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick Ronan O'Connell
- School of Medicine, University College Dublin, Dublin, Ireland.,Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - James F X Jones
- School of Medicine, University College Dublin, Dublin, Ireland
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Lee YJ, Yoon CY, Lee MS, Song BD, Lee SW, Jeong SJ. Effect of Early Sacral Neuromodulation on Bladder Function in a Rat Model of Incomplete Spinal Cord Injury Due to Focal Contusion. Neuromodulation 2018; 22:697-702. [PMID: 30506765 DOI: 10.1111/ner.12895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/23/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 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. MATERIALS AND METHODS 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. RESULTS 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 cmH2 O; p < 0.05) of nonvoiding contractions than the SHAM group. CONCLUSIONS 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.
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Affiliation(s)
- Young Ju Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Cheol Yong Yoon
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Seung Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung Do Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang Wook Lee
- Department of Urology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea
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Chang HH, Yeh JC, Mao J, Ginsberg DA, Ghoniem G, Rodriguez LV. Spinal cord stimulation ameliorates detrusor over-activity and visceromotor pain responses in rats with cystitis. Neurourol Urodyn 2018; 38:116-122. [PMID: 30411810 DOI: 10.1002/nau.23827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/04/2018] [Indexed: 01/07/2023]
Abstract
AIM Interstitial cystitis/painful bladder syndrome/(IC/PBS) results in recurring pain in the bladder and surrounding pelvic region caused by abnormal excitability of micturition reflexes. Spinal cord stimulation (SCS) is currently clinically used for the attenuation of neuropathic and visceral pain. The present study examined whether SCS at upper lumbar segments modulates detrusor overactivity and visceral hyperalgesia associated with cystitis in a rat model of cyclophosphamide (CYP)-induced cystitis. METHODS Cystitis was induced by intraperitoneal injection of CYP (200 mg/kg) in six adult female Sprague Dawley rats 48 h prior to urodynamic recordings. Another six rats served as-controls with saline injection. Cystometry and the external urethral sphincter (EUS) electromyography during bladder infusion were evaluated under urethane anesthesia. The visceromotor reflexes (VMR) obtained from the external abdominal oblique muscle were quantified during bladder infusion and isotonic bladder distension (IBD), respectively. After baseline recordings were taken, SCS was applied on the dorsal surface of L3 for 25 min. Urodynamic recordings and VMR during bladder infusion and IBD were repeated 2 h after SCS. RESULTS CYP resulted in detrusor overactivity, stronger EUS tonic contractions, and increased VMR. SCS significantly reduced non-voiding contractions, prolonged EUS relaxation, and delayed VMR appearance during bladder infusion as well as significantly decreased VMR during IBD in cystitis rats. CONCLUSION SCS improved bladder function and EUS relaxation during bladder infusion and significantly attenuated visceral nociceptive-related VMR during IBD in cystitis rats. SCS may have therapeutic potential for patients with hyperalgesia and IC/PBS.
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Affiliation(s)
- Huiyi H Chang
- Department of Urology, University of California Irvine, Irvine, California.,Reeve-Irvine Research Center, University of California Irvine, Irvine, California
| | - Jih-Chao Yeh
- Department of Urology, University of Southern California, Los Angeles, California
| | - Jackie Mao
- Department of Urology, University of Southern California, Los Angeles, California
| | - David A Ginsberg
- Department of Urology, University of Southern California, Los Angeles, California
| | - Gamal Ghoniem
- Department of Urology, University of California Irvine, Irvine, California
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, California
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Wang Z, Liao L, Deng H, li X, Chen G, Liao X. The different roles of opioid receptors in the inhibitory effects induced by sacral dorsal root ganglion stimulation on nociceptive and nonnociceptive conditions in cats. Neurourol Urodyn 2018; 37:2462-2469. [DOI: 10.1002/nau.23724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/09/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Zhaoxia Wang
- Department of Urology, China Rehabilitation Research Centre; Rehabilitation School of Capital Medical University; Beijing China
- Center of Neural Injury and Repair; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Neural Injury and Rehabilitation; Beijing China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre; Rehabilitation School of Capital Medical University; Beijing China
- Center of Neural Injury and Repair; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Neural Injury and Rehabilitation; Beijing China
| | - Han Deng
- Department of Urology, China Rehabilitation Research Centre; Rehabilitation School of Capital Medical University; Beijing China
- Center of Neural Injury and Repair; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Neural Injury and Rehabilitation; Beijing China
| | - Xing li
- Department of Urology, China Rehabilitation Research Centre; Rehabilitation School of Capital Medical University; Beijing China
- Center of Neural Injury and Repair; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Neural Injury and Rehabilitation; Beijing China
| | - Guoqing Chen
- Department of Urology, China Rehabilitation Research Centre; Rehabilitation School of Capital Medical University; Beijing China
- Center of Neural Injury and Repair; Beijing Institute for Brain Disorders; Beijing China
- Beijing Key Laboratory of Neural Injury and Rehabilitation; Beijing China
| | - Xiwen Liao
- School of Public Health; Yale University; New Haven Connecticut
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Ni J, Wang X, Cao N, Si J, Gu B. Efficacy of different spinal nerve roots for neuromodulation of micturition reflex in rats. Oncotarget 2018; 9:13382-13389. [PMID: 29568364 PMCID: PMC5862585 DOI: 10.18632/oncotarget.23950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022] Open
Abstract
Electrical stimulation of peripheral nerves controlling the bladder is an alternative, nondestructive medical treatment for urinary incontinence and retention. In this study, we aimed to identify the most efficient sensory and motor spinal nerve roots involved in the micturition reflex. Unilateral L5-S2 dorsal and ventral roots were electrically stimulated, and bladder reflex contractions were recorded under isovolumetric conditions. Repeated stimulation of the L6 and S1 dorsal roots not only abolished bladder reflex contractions but also induced a poststimulation inhibitory effect, whereas repeated stimulation of the L5 and S2 dorsal roots had no effect. Only the L6 ventral root directly caused bladder contraction when ventral roots L5-S2 were stimulated in sequence. Upon retrograde tracing using pseudorabies virus (PRV), the sacral parasympathetic nucleus of the L6 segment had more PRV-positive cells than the other segments, though the S1 segment of the dorsal root ganglia had the highest density of PRV-positive neurons. These results suggest the L6 ventral root is most efficient in producing detrusor muscle contraction, and the S1 dorsal root best inhibits the micturition reflex.
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Affiliation(s)
- Jianshu Ni
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaohu Wang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Nailong Cao
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiemin Si
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Baojun Gu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Uy J, Yu M, Jiang X, Jones C, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Glutamatergic Mechanisms Involved in Bladder Overactivity and Pudendal Neuromodulation in Cats. J Pharmacol Exp Ther 2017; 362:53-58. [PMID: 28428223 DOI: 10.1124/jpet.117.240895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 04/19/2017] [Indexed: 01/12/2023] Open
Abstract
The involvement of ionotropic glutamate receptors in bladder overactivity and pudendal neuromodulation was determined in α-chloralose anesthetized cats by intravenously administering MK801 (a NMDA receptor antagonist) or CP465022 (an AMPA receptor antagonist). Infusion of 0.5% acetic acid (AA) into the bladder produced bladder overactivity. In the first group of 5 cats, bladder capacity was significantly (P < 0.05) reduced to 55.3±10.0% of saline control by AA irritation. Pudendal nerve stimulation (PNS) significantly (P < 0.05) increased bladder capacity to 106.8 ± 15.0% and 106.7 ± 13.3% of saline control at 2T and 4T intensity, respectively. T is threshold intensity for inducing anal twitching. MK801 at 0.3 mg/kg prevented the increase in capacity by 2T or 4T PNS. In the second group of 5 cats, bladder capacity was significantly (P < 0.05) reduced to 49.0 ± 7.5% of saline control by AA irritation. It was then significantly (P < 0.05) increased to 80.8±13.5% and 79.0±14.0% of saline control by 2T and 4T PNS, respectively. CP465022 at 0.03-1 mg/kg prevented the increase in capacity by 2T PNS and at 0.3-1 mg/kg prevented the increase in capacity by 4T PNS. In both groups, MK801 at 0.3 mg/kg and CP465022 at 1 mg/kg significantly (P < 0.05) increased the prestimulation bladder capacity (about 80% and 20%, respectively) and reduced the amplitude of bladder contractions (about 30 and 20 cmH2O, respectively). These results indicate that NMDA and AMPA glutamate receptors are important for PNS to inhibit bladder overactivity and that tonic activation of these receptors also contributes to the bladder overactivity induced by AA irritation.
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Affiliation(s)
- Jamie Uy
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Michelle Yu
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Xuewen Jiang
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Cameron Jones
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Bing Shen
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Jicheng Wang
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - James R Roppolo
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - William C de Groat
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Changfeng Tai
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
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Cohn JA, Kowalik CG, Kaufman MR, Reynolds WS, Milam DF, Dmochowski RR. Evaluation of the axonics modulation technologies sacral neuromodulation system for the treatment of urinary and fecal dysfunction. Expert Rev Med Devices 2016; 14:3-14. [PMID: 27915486 DOI: 10.1080/17434440.2017.1268913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) remains one of the few effective treatments for refractory bladder and bowel dysfunction. However, SNM is associated with frequent need for surgical intervention, in many cases because of a failed battery. A rechargeable SNM system, with a manufacturer-reported battery life of 15 years or more, has entered post-market clinical testing in Europe but has not yet been approved for clinical testing in the United States. Areas covered: We review existing neuromodulation technologies for the treatment of lower urinary tract and bowel dysfunction and explore the limitations of available technology. In addition, we discuss implantation technique and device specifications and programming of the rechargeable SNM system in detail. Lastly, we present existing evidence for the use of SNM in bladder and bowel dysfunction and evaluate the anticipated trajectory of neuromodulation technologies over the next five years. Expert commentary: A rechargeable system for SNM is a welcome technological advance. However surgical revision not related to battery changes is not uncommon. Therefore, while a rechargeable system would be expected to reduce costs, it will not eliminate the ongoing maintenance associated with neuromodulation. No matter the apparent benefits, all new technologies require extensive post-market monitoring to ensure safety and efficacy.
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Affiliation(s)
- Joshua A Cohn
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Casey G Kowalik
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Melissa R Kaufman
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - W Stuart Reynolds
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Douglas F Milam
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Roger R Dmochowski
- a Department of Urologic Surgery , Vanderbilt University Medical Center , Nashville , TN , USA
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Jones J, Van de Putte D, De Ridder D, Knowles C, O'Connell R, Nelson D, Goessaert AS, Everaert K. A Joint Mechanism of Action for Sacral Neuromodulation for Bladder and Bowel Dysfunction? Urology 2016; 97:13-19. [DOI: 10.1016/j.urology.2016.05.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/15/2016] [Accepted: 05/01/2016] [Indexed: 12/27/2022]
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Dieter AA, Degoski DJ, Dolber PC, Fraser MO. The effects of bilateral bipolar sacral neurostimulation on urinary bladder activity during filling before and after irritation in a rat model. Neurourol Urodyn 2014; 34:387-91. [DOI: 10.1002/nau.22556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/17/2013] [Indexed: 01/23/2023]
Affiliation(s)
- Alexis A. Dieter
- Department of Obstetrics and Gynecology; Duke University Medical Center; Durham North Carolina
| | - Danielle J. Degoski
- Institute for Medical Research; Durham Veterans Affairs Medical Center; Durham North Carolina
| | - Paul C. Dolber
- Department of Research and Development; Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Matthew O. Fraser
- Institute for Medical Research; Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Research and Development; Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Surgery; Duke University Medical Center; Durham North Carolina
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Su X, Nickles A, Nelson DE. Neuromodulation attenuates bladder hyperactivity in a rat cystitis model. BMC Urol 2013; 13:70. [PMID: 24314228 PMCID: PMC4029505 DOI: 10.1186/1471-2490-13-70] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 12/03/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We investigated the regulation of urinary bladder function by electrical stimulation of the L6 spinal nerve (SN) using cystometry in normal rats and in rats with cystitis induced by intravesical infusion of dilute acetic acid. METHODS In anesthetized rats, a cannula was placed into the bladder dome for saline/acetic acid infusion and intravesical pressure monitoring. Threshold pressure (TP), basal pressure (BP) and inter-contraction interval (ICI) were measured from the bladder pressure recording and void volume (VV) was measured by weighing the voided fluid. RESULTS Comparison of cystometrograms obtained with infusion of saline or acetic acid showed that acetic acid decreases TP, ICI and VV. These excitatory effects, characteristic of acetic acid induced bladder hyperactivity, were significantly reversed by bilateral SN stimulation (P <0.05, vs pre-stimulation, Student t-test). In saline perfused rats, one hour of bilateral SN stimulation at 10 Hz and at motor threshold (0.19 ± 0.01 milliamps) increased ICI (265%) and VV (217%). In rats perfused with acetic acid, the corresponding increases produced by SN stimulation were 350% for ICI and 383% for VV. The percentage increases in the acetic acid-treated group were not significantly higher than those in saline-treated group. CONCLUSIONS Using continuous flow cystyometry, we find that SN stimulation can produce effects on micturition consistent with its effects on isovolumetric model, and consistent with the therapeutic effect observed with InterStim® therapy in overactive bladder patients. Although the effect of SN stimulation was slightly greater in bladder irritated over normal rats, the difference was not statistically significant.
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Affiliation(s)
- Xin Su
- Medtronic, Inc, Neuromodulation Research, 7000 Central Avenue, Minneapolis, MN 55432, USA.
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Martellucci J, Naldini G, Carriero A. Sacral nerve modulation in the treatment of chronic pelvic pain. Int J Colorectal Dis 2012; 27:921-6. [PMID: 22203519 DOI: 10.1007/s00384-011-1394-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic pelvic pain is a common condition that significantly compromises the quality of life of affected patients. Unfortunately, despite treatment procedures, the results are often ineffective and symptoms persist for years. For these reasons, the search for less aggressive treatment options with fewer negative consequences leading to minimally invasive techniques was conducted. OBJECTIVE The aim of the present study was to evaluate the efficacy of sacral nerve modulation in the treatment of chronic pelvic pain. Moreover, we aimed to identify potential predictors of positive results of sacral neuromodulation through the comparison between failed and successful patients. PATIENTS From January 2004 to December 2009, all consecutive patients suffering from chronic pelvic pain and tested for sacral nerve modulation in three pelvic floor dedicated centers were evaluated. Severity of symptoms were analyzed by a visual analog scale (VAS) RESULTS: Twenty-seven patients (2 males; mean age, 53 years) were tested for sacral nerve modulation in the screening period and were included in the present study. The mean duration of pain was 51 months (range, 10-132 months). The mean preoperative VAS was 7.8 (range, 5-10). Previous pelvic surgery was reported in 18 patients (66.5%). Sixteen patients (59%) fulfil the successful criteria and were definitively implanted. The mean follow-up was 37 months (range, 12-71 months). The mean preoperative VAS was 8.1 (range, 6-8) and decreased to 2.1 ± 1.2 at 6-month follow-up (p < 0.0001), to 2.1 ± 1.1 at 12 months (16 patients), to 2.0 ± 1.2 at 24 months (13 patients), to 2.3 ± 1.4 at 36 months (9 patients), to 2.1 ± 1.5 at 48 months (5 patients), and to 1.9 ± 1.3 at 60 months (3 patients). CONCLUSIONS Sacral neuromodulation proved to be effective in the treatment of some patients affected by chronic pelvic pain, and the effect persists over time. A positive screening phase and a positive response to gabapentin or pregabalin showed to be predictors of a successful response. Multiple localizations of pelvic pain and pain occurred after stapler surgery seem to be negative factors for the success of the treatment.
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Affiliation(s)
- J Martellucci
- General Surgery I, University of Siena, Ospedale Le Scotte viale Bracci, 1, 53100 Siena, Italy.
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12
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Su X, Nickles A, Nelson DE. Neuromodulation in a rat model of the bladder micturition reflex. Am J Physiol Renal Physiol 2011; 302:F477-86. [PMID: 22049401 DOI: 10.1152/ajprenal.00515.2011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A rat model of bladder reflex contraction (BRC) was used to determine the optimal frequency and intensity of spinal nerve (SN) stimulation to produce neuromodulation of bladder activity and to assess the therapeutic mechanisms of this neuromodulation. In anesthetized female rats (urethane 1.2 g/kg ip), a wire electrode was used to produce bilateral stimulation of the L6 SN. A cannula was placed into the bladder via the urethra, and the urethra was ligated to ensure an isovolumetric bladder. Saline infusion induced BRC. Electrical stimulation of the SN produced a frequency- and intensity-dependent attenuation of the frequency of bladder contractions. Ten-herz stimulation produced maximal inhibition; lower and higher stimulation frequency produced less attenuation of BRC. Attenuation of bladder contraction frequency was directly proportional to the current intensity. At 10 Hz, stimulation using motor threshold pulses (T(mot)) produced a delayed inhibition of the frequency of bladder contractions to 34 ± 11% of control. Maximal bladder inhibition appeared at 10 min poststimulation. High current intensity at 0.6 mA (∼6 * T(mot)) abolished bladder contraction during stimulation, and the inhibition was sustained for 10 min poststimulation (prolonged inhibition). Furthermore, in rats pretreated with capsaicin (125 mg/kg sc), stimulation produced a stronger inhibition of BRC. The inhibitory effects on bladder contraction may be mediated by both afferent and efferent mechanisms. Lower intensities of stimulation may activate large, fast-conducting fibers and actions through the afferent limb of the micturition reflex arc in SN neuromodulation. Higher intensities may additionally act through the efferent limb.
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Affiliation(s)
- Xin Su
- Medtronic, Inc., Neuromodulation Research, 7000 Central Ave. NE, RCE470, Minneapolis, MN 55432, USA.
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Vignes JR, Deloire M, Petry K. Animal models of sacral neuromodulation for detrusor overactivity. Neurourol Urodyn 2009; 28:8-12. [DOI: 10.1002/nau.20612] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Kessler TM, Fowler CJ. Sacral neuromodulation for urinary retention. ACTA ACUST UNITED AC 2008; 5:657-66. [DOI: 10.1038/ncpuro1251] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 10/13/2008] [Indexed: 11/09/2022]
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Minardi D, Ghiselli R, Lucarini G, Mocchegiani F, Filosa A, Zizzi A, Simonetti O, Orlando F, Pelliccioni G, Parri G, Saba V, Muzio LL, Biagini G, Montironi R, Muzzonigro G. Activity and Expression of Nitric Oxide Synthase in Rat Bladder after Sacral Neuromodulation. Int J Immunopathol Pharmacol 2008; 21:129-135. [DOI: 10.1177/039463200802100114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
The aim of our study is to investigate the effects of chronic sacral neuromodulation on Nitric Oxide (NO) metabolism in the rat bladder. 26 female Sprangue-Dawley rats were considered: group I, normal control rats; group II, a sham treatment, in whom catheters for electrical stimulation were placed in the S1 foramen bilaterally and left in place for 21 days, without performing neuromodulation; group III in whom electrical sacral neuromodulation was performed for 21 days. Finally a cystectomy was performed and the bladder biopsy specimens were sent for immunostaining with n-NOS and i-NOS. Morphological and immunohistochemical analysis was carried out, and evaluated in urothelial cells, endothelial cells and muscle fibers of the muscularis propria. Differences between the 3 groups were analyzed by Student Newman-Keuls test. We could observe that urothelial and endothelial i-NOS (37.00±4.69 and 59.00±7.42 respectively) and urothelial n-NOS (36.80±7.85) expression are significantly increased in neuromodulated rats, compared to groups 1 and 2 (p < 0.005). In conclusion, the increase of i-NOS expression on endothelial cells after sacral neuromodulation could be in some way related to angiogenetic responses in the microvascular structures; the increase of n-NOS and i-NOS expression on urothelial cells can suggest that NO is able to influence the plasticity of bladder response, inducing the release of messengers within the urothelium. This study can therefore improve our understanding of the mechanisms of sacral neuromodulation on chronic bladder dysfunction; further studies will need to better demonstrate the role of angiogenesis in the bladder after sacral neuromodulation and to investigate the effects of neuromodulation in rats with chronically induced bladder dysfunction.
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Affiliation(s)
| | - R. Ghiselli
- Institute of General Surgery (INRCA-IRRCS), Polytechnic University of the Marche Region, Ancona
| | - G. Lucarini
- Department of Molecular Pathology and Innovative Therapies-Histology, Polytechnic University of the Marche Region, Ancona
| | - F. Mocchegiani
- Institute of General Surgery (INRCA-IRRCS), Polytechnic University of the Marche Region, Ancona
| | - A. Filosa
- Institute of Pathology, Polytechnic University of the Marche Region, Ancona
| | - A. Zizzi
- Department of Molecular Pathology and Innovative Therapies-Histology, Polytechnic University of the Marche Region, Ancona
| | - O. Simonetti
- Clinic of Dermatology, Polytechnic University of the Marche Region, Ancona
| | - F. Orlando
- Biotechnology Centre Research Department, department of Neurology, INRCA-IRRCS, Ancona
| | - G. Pelliccioni
- Department of Surgical Science, University of Foggia, Foggia, Italy
| | | | - V. Saba
- Institute of General Surgery (INRCA-IRRCS), Polytechnic University of the Marche Region, Ancona
| | | | - G. Biagini
- Department of Molecular Pathology and Innovative Therapies-Histology, Polytechnic University of the Marche Region, Ancona
| | - R. Montironi
- Institute of Pathology, Polytechnic University of the Marche Region, Ancona
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Abstract
Voiding dysfunction, which includes incontinence, retention, and chronic pelvic pain, is a relatively frequent problem that can be difficult to manage. Neuromodulation via stimulation of the sacral nerves has been shown to improve these symptoms, although the exact mechanisms remain elusive. Techniques for nerve stimulation may vary, depending on the disease, location of pain, and the patient's anatomy. In addition to placement of electrodes on the sacral nerve roots, modulation has also been reported by peripheral branches of the sacral nerves including the pudendal and posterior tibial nerves. Newer surgical techniques have significantly decreased the morbidity of the procedures and increased the probability of a successful outcome.
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Affiliation(s)
- Robert D Mayer
- Department of Urology, University of Rochester, Rochester, New York 14642, USA.
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van der Pal F, Heesakkers JPFA, Bemelmans BLH. Current opinion on the working mechanisms of neuromodulation in the treatment of lower urinary tract dysfunction. Curr Opin Urol 2006; 16:261-7. [PMID: 16770125 DOI: 10.1097/01.mou.0000232047.87803.1e] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Neuromodulation is a successful treatment for patients with refractory lower urinary tract dysfunction. In the recent years, more applications of various types and ways have been developed and put into clinical practice. It is important, therefore, for urologists to know the existing theories on the working mechanisms that explain the effect. Although much research has been devoted to this subject for the past 35 years, the working mechanism is still unknown. This review presents an overview of the different theories and research into the physiological background of neuromodulation during the past 3 decades with emphasis on recent developments. RECENT FINDINGS Specific receptors in the spinal cord have been identified, which are involved in the working mechanism of neuromodulation. The maximal effect of neuromodulation is not directly reached, indicating that neuromodulation induces learning changes (i.e. neural plasticity). The carry-over effect could be caused by negative modulation of excitatory synapses in the central micturition reflex pathway. SUMMARY Neuromodulation in the treatment of stress incontinence probably induces physiological changes in the sphincter muscles and pelvic floor. In the treatment of overactive bladder syndrome, nonobstructive voiding dysfunction and chronic pelvic pain, the mechanism of action seems to be more complicated. Most likely, it is a combination of the different suggested modes of action, involving the neuroaxis at different levels.
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Affiliation(s)
- Floor van der Pal
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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