ABSTRACT
PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P0.05). CONCLUSIONS: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.
Subject(s)
Humans , Acetic Acid , Reflex , Spinal Nerves , Swine , Tail , Urinary Bladder , Urinary Bladder, Overactive , UrinationABSTRACT
Objective To evaluate the efficacy of the intravesical injection of botulinum toxin A (BTX-A) and bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation in patients with interstitial cystitis/bladder pain syndrome (IC/BPS).Methods We retrospectively reviewed 153 women with IC/BPS from January 2003 to December 2015.Of the 153 patients,77 were treated with BTX-A(group A),the average age was (56.0 ± 4.1) years old.76 underwent bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation (group B),the average age was (58.0 ± 3.3) years old.The patients were evaluated using the O'Leafy-Saint score,visual analog scale pain score,urinary frequency record and quality of life questionnaire before treatment and 1 week,1,3,6 and 12 months after treatment.Results In group A,only 2 had acute urinary retention,27 received a repeat injection,and 28 were lost to follow-up.In group B,3 had urinary tract infection,15 switched to BTX-A injection at 6 months because the treatment of hydrodistention plus Cystistat instillation is not good.31 were lost to follow-up.BTX-A was shown to remain effective for up to 6 months after treatment.After repeated Chinese BTX-A injections,symptoms improved significantly.Hydrodistention plus Cystistat remained effective for up to 3 months after treatment.Conclusions Intravesical injection of BTX-A is a effective therapeutic option for patients with IC/BPS.The average duration of the effect of one dose of Chinese BTX-A was 6 months.Repeated injection of BTX-A is effective.
ABSTRACT
Objective In order to observe central responses during naturally occurring urinary bladder storage in healthy subjects,we examined brain areas that control strong bladder sensation by resting-state functional magnetic resonance imaging (rs-fMRI).Methods 44 healthy subjects (19 men and 25 women,between 22 and 50 years of age) were screened in the study from October 2014 to October 2016.All subjects were right-handed and scanned twice under the following two conditions:empty bladder (bladder volume ＜ 10 ml)and full bladder (‘strong desire to void’,bladder volume between 200 and 400 ml)without the use of filling with a catheter.Brain imaging softwares (SPM8,DPABI,REST) were adopted to analyze the difference in brain-blood perfusion between these two conditions.Voxel-based analysis of the regional homogeneity (ReHo) was performed to analyze rs-fMRI data including the main excitatory regions and inhibitory areas,peak value (X-axis,Y-axis,Z-axis),clusters size (active volume unit:number of voxel),T value (the excitatory and inhibitory extent of brain active regions).Results The rs-fMRI scans of 44 healthy subjects were analyzed.Nine subjects were excluded because of excessive head movements of more than 1.5 mm and 1.5° in rotation.Data sets were obtained from 35 subjects in two states of bladder,empty bladder and strong desires to void.Increased activity during strong desire to void was observed in the prefrontal cortex (PFC),anterior cingulate cortex (ACC),hypothalamus,temporal lobes and left caudate nucleus.Conclusions There are significant changes in the brain's ReHo during the strong sensation to void.The results suggest that the PFC,the ACC,hypothalamus,temporal lobes and left caudate nucleus play a role in the cerebral control of bladder storage without artificial bladder filling in healthy people.