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Ness TJ, McNaught J, Clodfelder-Miller B, Nelson DE, Su X. Neuromodulatory effects of pudendal nerve stimulation on bladder hypersensitivity are present in opioid-pretreated rats. Reg Anesth Pain Med 2019; 44:rapm-2018-100353. [PMID: 31488554 DOI: 10.1136/rapm-2018-100353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/16/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Bilateral electrical pudendal nerve stimulation (bPNS) reduces bladder hypersensitivity in rat models and anecdotally reduces pain in humans with pelvic pain of urologic origin. Concomitant opioids are known to alter responses to neuromodulation in some systems. So prior to the development of a clinical trial for purposes of regulatory approval, the preclinical interaction between opioids and stimulation effectiveness was examined. METHODS Bladder hypersensitivity was produced by neonatal bladder inflammation in rat pups coupled with a second inflammatory insult as an adult. Morphine was administered acutely (1-4 mg/kg intraperitoneal) or chronically (5 mg/kg subcutaneously daily for 2 weeks prior to the terminal experiment). bPNS consisted of bilateral biphasic electrical stimulation of the mixed motor/sensory component of the pudendal nerves. Visceromotor responses (VMR; abdominal muscle contractile responses to urinary bladder distension (UBD)) were used as nociceptive endpoints. RESULTS Morphine produced a dose-dependent inhibition of VMRs to UBD that was naloxone reversible. bPNS resulted in statistically significant inhibition of VMRs to UBD in hypersensitive rats that had received acute or chronic subcutaneous morphine injections. CONCLUSIONS This study suggests that inhibitory effects of bPNS can still be evoked in subjects who are receiving opioid therapy, thus giving guidance to potential clinical trials seeking regulatory approval for the treatment of chronic bladder pain.
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Affiliation(s)
- Timothy John Ness
- Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamie McNaught
- Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Dwight E Nelson
- Global Neuromodulation Research, Medtronic, Inc, Minneapolis, Minnesota, USA
| | - Xin Su
- Global Neuromodulation Research, Medtronic, Inc, Minneapolis, Minnesota, USA
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Hotta H, Watanabe N. Gentle Perineal Skin Stimulation for Control of Nocturia. Anat Rec (Hoboken) 2019; 302:1824-1836. [PMID: 30980505 DOI: 10.1002/ar.24135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 10/30/2018] [Accepted: 11/18/2018] [Indexed: 11/06/2022]
Abstract
One of the major causes of nocturia is overactive bladder (OAB). Somatic afferent nerve stimuli are used for treating OAB. However, clinical evidence for the efficacy of this treatment is insufficient due to the lack of appropriate control stimuli. Studies on anesthetized animals, which eliminate emotional factors and placebo effects, have demonstrated an influence of somatic stimuli on urinary bladder functions and elucidated the underlying mechanisms. In general, the effects of somatic stimuli are dependent on the modality, location, and physical characteristics of the stimulus. Recently we showed that gentle stimuli applied to the perineal skin using a soft elastomer roller inhibited micturition contractions to a greater extent than a roller with a hard surface. Studies aiming to elucidate the neural mechanisms of gentle stimulation-induced inhibition reported that 1-10 Hz discharges of low-threshold cutaneous mechanoreceptive Aβ, Aδ, and C fibers evoked during stimulation with an elastomer roller inhibited the micturition reflex by activating the spinal cord opioid system, thereby reducing both ascending and descending transmission between bladder and pontine micturition center. The present review will provide a brief summary of (1) the effect of somatic electrical stimulation on the micturition reflex, (2) the effect of gentle mechanical skin stimulation on the micturition reflex, (3) the afferent, efferent, and central mechanisms underlying the effects of gentle stimulation, and (4) a translational clinical study demonstrating the efficacy of gentle skin stimuli for treating nocturia in the elderly with OAB by using the two roller types inducing distinct effects on rat micturition contractions. Anat Rec, 302:1824-1836, 2019. © 2019 American Association for Anatomy.
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Affiliation(s)
- Harumi Hotta
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Nobuhiro Watanabe
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Ness TJ, DeWitte C, McNaught J, Clodfelder-Miller B, Su X. Spinal mechanisms of pudendal nerve stimulation-induced inhibition of bladder hypersensitivity in rats. Neurosci Lett 2018; 686:181-185. [PMID: 30218768 PMCID: PMC6204288 DOI: 10.1016/j.neulet.2018.08.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/07/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022]
Abstract
Bilateral electrical pudendal nerve stimulation (bPNS) reduces bladder hypersensitivity in rat models of bladder pain and anecdotally reduces pain in humans with pelvic pain of urologic origin. The spinal neurochemical mechanisms of this antinociception are unknown. In the present study, bladder hypersensitivity was produced by neonatal bladder inflammation in rat pups coupled with a second inflammatory insult as an adult. Visceromotor responses (VMRs; abdominal muscle contractions) to urinary bladder distension (UBD) were used as a nociceptive endpoint under urethane-isoflurane anesthesia. bPNS consisted of bilateral biphasic electrical stimulation of the mixed motor/sensory component of the pudendal nerves. Following determination of the inhibitory effect of bPNS on VMRs, pharmacological antagonists were administered via an intrathecal catheter onto the lumbosacral spinal cord and bPNS effects on VMRs redetermined. bPNS resulted in statistically significant inhibition of VMRs to UBD in hypersensitive rats that was statistically reduced by the intrathecal administration of methysergide, WAY100636, CGP35348 and strychnine but was unaffected by naloxone, bicuculline, phentolamine, ondansetron and normal saline. This study suggests that inhibitory effects of bPNS may include serotonergic, GABA-B-ergic and glycinergic mechanisms suggesting the potential for interaction of the neuromodulatory effect with concommitant drug therapies.
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Affiliation(s)
- Timothy J Ness
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, United States of America.
| | - Cary DeWitte
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, United States of America
| | - Jamie McNaught
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, United States of America
| | - Buffie Clodfelder-Miller
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, United States of America
| | - Xin Su
- Neuromodulation Research, Medtronic, Inc, United States of America
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Langlois L, Antor M, Atmani K, Le Long E, Merriaux P, Bridoux V, Dechelotte P, Leroi AM, Meleine M, Gourcerol G. Development of a Remote-Controlled Implantable Rat Sacral Nerve Stimulation System. Neuromodulation 2018; 22:690-696. [PMID: 30346640 DOI: 10.1111/ner.12870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Sacral nerve stimulation (SNS) is a surgical treatment of urinary and fecal incontinence. Despite its clinical efficacy, the mechanisms of action of SNS are still poorly known. This may be related to the use of acute stimulation models. Up to date, no rodent model of chronic SNS implants has been developed. Therefore, the aim of this study was to create a fully implantable and remotely controllable stimulating device to establish an animal model of chronic SNS. MATERIALS AND METHODS The stimulating device consisted of an implantable pulse generator linked to a platinum electrode. The communication with the device was made through an inductive link which allowed to adjust the stimulation parameters; that is, to turn the device on and off or check the battery status remotely. Rats underwent two surgical procedures. In the first procedure, we achieved chronic sacral stimulation but the implanted electrode was not fixated. In the second procedure, the electrode was fixated in the sacral foramen using dental resin. In both cases, the correct positioning of the electrode was evaluated by computed tomography (CT) imaging and the presence of tail tremor in response to high intensity stimulation. We only tested the function of implanted electrode with fixation using micturition frequency assessment following bipolar or unipolar SNS for three days after recovery. RESULTS CT imaging showed that implantation of the electrode required fixation as we found that the second surgical procedure yielded a more precise placement of the implanted electrode. The correct placement of implanted electrode observed with imaging was always correlated with a successful tail tremor response in rats, therefore we pursued our next experiments with the second surgical procedure and only assessed the tail tremor response. We found that both bipolar and unipolar SNS reduced micturition frequency. CONCLUSION This stimulating device provides an efficient method to perform chronic SNS studies in rats.
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Affiliation(s)
- Ludovic Langlois
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - Marlène Antor
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Karim Atmani
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - Erwan Le Long
- Department of Urology, Rouen University Hospital, Rouen, France
| | - Pierre Merriaux
- Embedded Electronic Systems Research Institute, Saint-Etienne du Rouvray, France
| | - Valérie Bridoux
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Pierre Dechelotte
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - Anne Marie Leroi
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France
| | - Mathieu Meleine
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - Guillaume Gourcerol
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France
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Su X, Simenson HA, Paralikar K, Orser HD. Comparison of Bladder Inhibitory Effects of Patterned Spinal Nerve Stimulation With Conventional Neuromodulation in the Rat. Neuromodulation 2017; 20:787-792. [PMID: 28782237 DOI: 10.1111/ner.12640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The present study compared the effectiveness of patterned frequency of spinal nerve stimulation (SNS) with continuous, fixed-frequency nerve stimulation in an animal model of the bladder reflex contraction (BRC). MATERIALS AND METHODS In anesthetized female rats, wire electrodes were placed under each of the L6 spinal nerve to produce bilateral SNS. A cannula was placed into the bladder via the urethra, and the urethra was ligated to ensure an isovolumetric bladder. RESULTS Using motor threshold intensity, continuous stimulation at fixed frequencies of 4 Hz (n = 5) and 10 Hz (n = 7) decreased the frequency of BRC of 71 ± 24% (mean, SEM) and 85 ± 18% of controls, respectively (vs. no stimulation, n = 10, p < 0.05, two-way analysis of variance [ANOVA]). Fixed-frequency stimulation at 0.01, 0.1, 1, 40, and 100 Hz, did not demonstrate a trend change on BRC. When stimulation frequency is delivered with a 4-6 pulse/burst pattern every 1-100 sec, neuromodulation has demonstrated a trend toward effectiveness, with a four-pulse 40 Hz burst stimulation per second showing the most difference, reducing the BRC frequency of 74 ± 8% of control (n = 8, p < 0.05, two-way ANOVA). However, it is not more effective than continuous neuromodulation at a fixed frequency of 4 Hz or 10 Hz at BRC inhibition. CONCLUSIONS Burst stimulations may inhibit bladder contractions; however, they are not more effective than continuous neuromodulation. Without further knowledge regarding mechanisms and potential benefit of burst stimulation on bladder control in patients with neuropathological conditions, applications should utilize continuous fixed 10 Hz stimulation for maximal clinical outcomes.
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Affiliation(s)
- Xin Su
- Medtronic, Inc., Restorative Therapies Group, Research & Core Technology, Minneapolis, MN, USA
| | - Heather A Simenson
- Medtronic, Inc., Physiological Research Laboratories, Minneapolis, MN, USA
| | - Kunal Paralikar
- Medtronic, Inc., Restorative Therapies Group, Research & Core Technology, Minneapolis, MN, USA
| | - Heather D Orser
- Medtronic, Inc., Restorative Therapies Group, Research & Core Technology, Minneapolis, MN, USA
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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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Su X, Nickles A, Nelson DE. Optimization of Neuromodulation for Bladder Control in a Rat Cystitis Model. Neuromodulation 2015; 19:101-7. [PMID: 26517575 DOI: 10.1111/ner.12360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/09/2015] [Accepted: 09/15/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In a bladder overactivity model of cystitis induced by intravesical infusion of acetic acid (a.a.), several parameters of spinal nerve stimulation (SNS) were optimized using continuous infusion cystometry. The optimal stimulation was further characterized through measurements of urodynamic function using single-fill cystometry. MATERIALS AND METHODS In anesthetized male rats, a cannula was placed into the bladder dome for saline or 0.3% a.a. infusion and intravesical pressure monitoring. For SNS, two teflon-coated stainless steel electrodes were placed bilaterally under each of the L6 spinal nerves, and current stimulation was controlled independently using two Grass stimulators. RESULTS Stimulation of 1 Hz or 50 Hz at motor threshold (Tmot ) was ineffective for altering bladder activities, but 10-Hz SNS increased the infused volume (IV) in a stimulation intensity-dependent fashion (P < 0.01, mixed model repeated analysis). Pairwise comparisons of IV differences to each stimulation intensity show that IV during 1 × Tmot stimulation was significantly larger than 0 × Tmot (no stim, P = 0.001), while the IV during 2 × Tmot stimulation was significantly larger than other intensities tested (P < 0.01). The mean IV (±SEM) during 0 × Tmot (no stim), 0.5 × Tmot , 1 × Tmot , and 2 × Tmot were 0.23 ± 0.04 mL, 0.25 ± 0.03 mL, 0.26 ± 0.03 mL, and 0.40 ± 0.04 mL, respectively. In single-fill cystometry, 10-Hz SNS at 1 × Tmot and 2 × Tmot stimulation increased the IV, or voiding duration and threshold pressure. SNS did not produce significant effects on basal pressure and micturition pressure. CONCLUSIONS SNS significantly attenuates hypersensitive micturition reflex; 10 Hz and high-intensity stimulation are mostly effective. Acute peripheral nerve activation increases the functional bladder capacity, which may be via mechanisms on the afferent arm of the bladder micturition reflex.
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Affiliation(s)
- Xin Su
- Neuromodulation Research, Medtronic, Inc, Minneapolis, MN, USA
| | - Angela Nickles
- Physiological Research Laboratories, Medtronic, Inc, Minneapolis, MN, USA
| | - Dwight E Nelson
- Neuromodulation Research, Medtronic, Inc, Minneapolis, MN, USA
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Zhang Z, Slater RC, Ferroni MC, Kadow BT, Lyon TD, Shen B, Xiao Z, Wang J, Kang A, Roppolo JR, de Groat WC, Tai C. Role of µ, κ, and δ opioid receptors in tibial inhibition of bladder overactivity in cats. J Pharmacol Exp Ther 2015; 355:228-34. [PMID: 26354994 DOI: 10.1124/jpet.115.226845] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/18/2015] [Indexed: 02/03/2023] Open
Abstract
In α-chloralose anesthetized cats, we examined the role of opioid receptor (OR) subtypes (µ, κ, and δ) in tibial nerve stimulation (TNS)-induced inhibition of bladder overactivity elicited by intravesical infusion of 0.25% acetic acid (AA). The sensitivity of TNS inhibition to cumulative i.v. doses of selective OR antagonists (cyprodime for µ, nor-binaltorphimine for κ, or naltrindole for δ ORs) was tested. Naloxone (1 mg/kg, i.v., an antagonist for µ, κ, and δ ORs) was administered at the end of each experiment. AA caused bladder overactivity and significantly (P < 0.01) reduced bladder capacity to 21.1% ± 2.6% of the saline control. TNS at 2 or 4 times threshold (T) intensity for inducing toe movement significantly (P < 0.01) restored bladder capacity to 52.9% ± 3.6% or 57.4% ± 4.6% of control, respectively. Cyprodime (0.3-1.0 mg/kg) completely removed TNS inhibition without changing AA control capacity. Nor-binaltorphimine (3-10 mg/kg) also completely reversed TNS inhibition and significantly (P < 0.05) increased AA control capacity. Naltrindole (1-10 mg/kg) reduced (P < 0.05) TNS inhibition but significantly (P < 0.05) increased AA control capacity. Naloxone (1 mg/kg) had no effect in cyprodime pretreated cats, but it reversed the nor-binaltorphimine-induced increase in bladder capacity and eliminated the TNS inhibition remaining in naltrindole pretreated cats. These results indicate a major role of µ and κ ORs in TNS inhibition, whereas δ ORs play a minor role. Meanwhile, κ and δ ORs also have an excitatory role in irritation-induced bladder overactivity.
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Affiliation(s)
- Zhaocun Zhang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Richard C Slater
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Matthew C Ferroni
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Brian T Kadow
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Timothy D Lyon
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Bing Shen
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Zhiying Xiao
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Jicheng Wang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Audry Kang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - James R Roppolo
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - William C de Groat
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
| | - Changfeng Tai
- Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (Z.Z.); Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania (Z.Z., R.C.S., M.C.F., B.K., T.D.L., B.S., Z.X., J.W., A.K., C.T.); Department of Urology, The Second Hospital, Shandong University, Jinan, P.R. China (Z.X.); and the Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania (J.R.R., W.C.D., C.T.)
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Hotta H, Watanabe N. Gentle Mechanical Skin Stimulation Inhibits Micturition Contractions via the Spinal Opioidergic System and by Decreasing Both Ascending and Descending Transmissions of the Micturition Reflex in the Spinal Cord. PLoS One 2015; 10:e0135185. [PMID: 26252000 PMCID: PMC4529237 DOI: 10.1371/journal.pone.0135185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/19/2015] [Indexed: 01/23/2023] Open
Abstract
Recently, we found that gentle mechanical skin stimulation inhibits the micturition reflex in anesthetized rats. However, the central mechanisms underlying this inhibition have not been determined. This study aimed to clarify the central neural mechanisms underlying this inhibitory effect. In urethane-anesthetized rats, cutaneous stimuli were applied for 1 min to the skin of the perineum using an elastic polymer roller with a smooth, soft surface. Inhibition of rhythmic micturition contractions by perineal stimulation was abolished by naloxone, an antagonist of opioidergic receptors, administered into the intrathecal space of the lumbosacral spinal cord at doses of 2–20 μg but was not affected by the same doses of naloxone administered into the subarachnoid space of the cisterna magna. Next, we examined whether perineal rolling stimulation inhibited the descending and ascending limbs of the micturition reflex. Perineal rolling stimulation inhibited bladder contractions induced by electrical stimulation of the pontine micturition center (PMC) or the descending tract of the micturition reflex pathway. It also inhibited the bladder distension-induced increase in the blood flow of the dorsal cord at L5–S1, reflecting the neural activity of this area, as well as pelvic afferent-evoked field potentials in the dorsal commissure at the lumbosacral level; these areas contain long ascending neurons to the PMC. Neuronal activities in this center were also inhibited by the rolling stimulation. These results suggest that the perineal rolling stimulation activates the spinal opioidergic system and inhibits both ascending and descending transmissions of the micturition reflex pathway in the spinal cord. These inhibitions would lead to the shutting down of positive feedback between the bladder and the PMC, resulting in inhibition of the micturition reflex. Based on the central neural mechanisms we show here, gentle perineal stimulation may be applicable to several different types of overactive bladder.
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Affiliation(s)
- Harumi Hotta
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- * E-mail:
| | - Nobuhiro Watanabe
- Department of Autonomic Neuroscience, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Su X, Nickles A, Nelson DE. Preclinical assessment of potential interactions between botulinum toxin and neuromodulation for bladder micturition reflex. BMC Urol 2015; 15:50. [PMID: 26055982 PMCID: PMC4460855 DOI: 10.1186/s12894-015-0048-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/03/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND While botulinum toxin A (BoNT-A) has become a more commonly used second-line treatment for patients with detrusor overactivity, it remains unknown whether the impacts of this therapy may persist to influence other therapies such as sacral neuromodulation. In this preclinical study we have evaluated urodynamic functions to intradetrusor injection of BoNT-A and the bladder inhibitory effects of spinal nerve stimulation (SNS) following BoNT-A treatment. METHODS Female rats were anesthetized with 3 % isoflurane. BoNT-A (2 units, 0.2 ml) or saline were injected into the detrusor. Rats then were housed for 2 days to 1 month before neuromodulation study. Monopolar electrodes were placed under each of the L6 spinal nerve bilaterally under urethane anesthesia. A bladder cannula was inserted via the urethra for saline infusion and intravesical pressure recording. RESULTS Intradetrusor injection of BoNT-A for 1-2 weeks or 1 month significantly increased bladder capacity compared with saline injection (p < 0.05, two-way ANOVA). Following BoNT-A, SNS attenuated the frequency of bladder contractions, either eliminating bladder contractions or reducing the contraction frequency during electrical stimulation. Inhibition of the contraction frequency by SNS following BoNT-A treated rats was not different from that measured following saline injection. CONCLUSIONS BoNT-A increased the bladder capacity, but compensating for additional saline infusion to the enlarged urinary bladder in BoNT-A pretreated rats, the bladder contractions induced by bladder filling were attenuated by SNS. BoNT-A did not alter the ability of SNS to inhibit bladder contraction following intradetrusor injection of BoNT-A for 2 days, 1-2 weeks or 1 month. These results support further pre-clinical and clinical studies to evaluate potential interactions or combination therapy with neuromodulation and intradetrusor BoNT-A therapeutic approaches.
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Affiliation(s)
- Xin Su
- Medtronic plc, Neuromodulation Research, 7000 Central Avenue, Minneapolis, MN, 55432, USA.
| | - Angela Nickles
- Physiological Research Laboratories, 7000 Central Avenue, Minneapolis, MN, 55432, USA.
| | - Dwight E Nelson
- Medtronic plc, Neuromodulation Research, 7000 Central Avenue, Minneapolis, MN, 55432, USA.
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de Groat WC, Tai C. Impact of Bioelectronic Medicine on the Neural Regulation of Pelvic Visceral Function. Bioelectron Med 2015; 2015:25-36. [PMID: 26491706 PMCID: PMC4610375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Neuromodulation elicited by electrical stimulation of peripheral or spinal nerves is a U.S. Food and Drug Administered (FDA)-approved therapy for treating disorders of the pelvic viscera, including urinary urgency, urgency-frequency, nonobstructive urinary retention and fecal incontinence. The technique is also being tested experimentally for its efficacy in treating interstitial cystitis, chronic constipation and pelvic pain. The goal of neuromodulation is to suppress abnormal visceral sensations and involuntary reflexes and restore voluntary control. Although detailed mechanisms underlying the effects of neuromodulation are still to be elucidated, it is generally believed that effects are due to stimulation of action potentials in somatic afferent nerves. Afferent nerves project to the lumbosacral spinal cord, where they release excitatory neurotransmitters that activate ascending pathways to the brain or spinal circuits that modulate visceral sensory and involuntary motor mechanisms. Studies in animals revealed that different types of neuromodulation (for example, stimulation of a sacral spinal root, pudendal nerve or posterior tibial nerve) act by releasing different inhibitory and excitatory neurotransmitters in the central nervous system. In addition, certain types of neuromodulation inhibit visceral smooth muscle by initiating reflex firing in peripheral autonomic nerves or excite striated sphincter muscles by initiating reflex firing in somatic efferent nerves. This report will provide a brief summary of (a) neural control of the lower urinary tract and distal bowel, (b) clinical use of neuromodulation in the treatment of bladder and bowel dysfunctions,
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Affiliation(s)
- William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States of America
| | - Changfeng Tai
- Department of Pharmacology and Chemical Biology, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States of America
- Department of Urology, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States of America
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13
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de Groat WC, Tai C. Impact of Bioelectronic Medicine on the Neural Regulation of Pelvic Visceral Function. Bioelectron Med 2015. [DOI: 10.15424/bioelectronmed.2015.00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Abstract
This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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Su X, Brink T, Nickles A, Nelson DE. Neuromodulation on Bladder Capacity in Conscious Sheep1. J Med Device 2014. [DOI: 10.1115/1.4027023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Xin Su
- Global Neuromodulation Research, Minneapolis, MN 55432
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Matsuta Y, Roppolo JR, de Groat WC, Tai C. Poststimulation inhibition of the micturition reflex induced by tibial nerve stimulation in rats. Physiol Rep 2014; 2:e00205. [PMID: 24744884 PMCID: PMC3967688 DOI: 10.1002/phy2.205] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 12/25/2013] [Accepted: 01/06/2014] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to determine the effect of tibial nerve stimulation (TNS) on the micturition reflex. Experiments were conducted in 24 rats under urethane anesthesia. A catheter was inserted into the bladder via the bladder dome for saline infusion. A cuff electrode was placed around right tibial nerve for stimulation. TNS (5 Hz, 0.2 msec pulse width) at 2–4 times the threshold (T) intensity for inducing a toe movement was applied either during slow (0.08 mL/min) infusion of the bladder or for 30 min with an empty bladder. TNS had no effect on the micturition reflex when it was applied during slow bladder infusion. However, the 30‐min TNS applied with an empty bladder induced poststimulation inhibition and significantly (P < 0.05) increased the bladder capacity to about 140% of prestimulation level in a 50‐min period following the termination of stimulation. The bladder compliance was also significantly (P < 0.05) increased after the 30‐min TNS. These results suggest that different mechanisms might exist in acute‐ and post‐TNS inhibition of micturition reflex. The animal model developed in this study will be very useful for further investigations of the neurotransmitter mechanisms underlying tibial neuromodulation of bladder function. This study suggests that different mechanisms might exist in acute‐ and poststimulation tibial inhibition of the micturition reflex. The animal model developed in this study is very useful for further investigations of the neurotransmitter mechanisms underlying tibial neuromodulation of bladder function.
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Affiliation(s)
- Yosuke Matsuta
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania ; Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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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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Su X, Nickles A, Nelson DE. Differentiation and interaction of tibial versus spinal nerve stimulation for micturition control in the rat. Neurourol Urodyn 2013; 34:92-7. [PMID: 24151044 PMCID: PMC4282097 DOI: 10.1002/nau.22506] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/04/2013] [Indexed: 11/06/2022]
Abstract
AIMS To determine time course of the bladder inhibitory response to unilateral or bilateral stimulation of the tibial nerve (TN) and spinal nerve (SN) as well as the interaction of stimulation at these two sites. METHODS In anesthetized female rats, a wire electrode was placed under either one or both of the TN or L6 SN. A cannula was placed into the bladder via the urethra. Saline infusion induced bladder rhythmic contraction (BRC). RESULTS Compared to SN neuromodulation, TN neuromodulation is less efficacious. The first 5-min stimulation at three times motor threshold on the SN and TN decreased the BRC frequency to 9% and 69% of controls, respectively. In contrast to SN stimulation, bilateral TN neuromodulation is not more effective than unilateral and sustained TN stimulation results in an apparent desensitization of the bladder response. If a 15-min TN stimulation was applied, BRCs were shutdown only during the first 5 min of stimulation. If a 5-min stimulation, using sufficient current to abolish BRC, is repeated, at least 20 min between stimulations was required in order for the responses to the first and second stimulations to be equivalent. Finally, stimulation of the TN combined with SN never produced a significantly greater effect than TN or SN stimulation alone. CONCLUSIONS Based on the current experiments, it would appear that SN neuromodulation of bladder activity is preferable to TN stimulation and there is no evidence to suggest that stimulation at both sites would offer a therapeutic advantage over spinal stimulation alone.
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Affiliation(s)
- Xin Su
- Medtronic, Inc., Neuromodulation Research, Minneapolis, Minnesota
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Su X, Nickles A, Nelson DE. Quantification of effectiveness of bilateral and unilateral neuromodulation in the rat bladder rhythmic contraction model. BMC Urol 2013; 13:34. [PMID: 23866931 PMCID: PMC3718626 DOI: 10.1186/1471-2490-13-34] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 07/17/2013] [Indexed: 11/25/2022] Open
Abstract
Background Using the isovolumetric bladder rhythmic contraction (BRC) model in anesthetized rats, we have quantified the responsiveness to unilateral and bilateral stimulation of the L6 spinal nerve (SN) and characterized the relationship between stimulus intensity and inhibition of the bladder micturition reflex. Methods A wire electrode was placed under either one or both of the L6 SN roots. A cannula was placed into the bladder via the urethra and the urethra was ligated. Saline infusion induced BRC. Results At motor threshold (Tmot) intensity, SN stimulation of both roots (10 Hz) for 10 min reduced bladder contraction frequency from 0.63 ± 0.04 to 0.17 ± 0.09 contractions per min (26 ± 14% of baseline control; n = 10, p < 0.05). However, the same intensity of unilateral stimulation (n = 15) or sequential stimulation of both SNs (e.g. 5 min per side alternatively for a total of 10 min or 20 min) was less efficacious. The greater sensitivity to bilateral stimulation is not dependent upon precise bilateral timing of the stimulation pulses. Bilateral stimulation also produced both acute and prolonged- inhibition on bladder contractions in a stimulation intensity dependent fashion. Conclusions Using the bladder rhythmic contraction model, bilateral stimulation was more effective than unilateral stimulation of the SN. Clinical testing should be conducted to further compare efficacies of unilateral and bilateral stimulation. Bilateral stimulation may allow the use of lower stimulation intensities to achieve higher efficacy for neurostimulation therapies on urinary tract control.
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