Tibial nerve stimulation using adhesive skin surface electrodes to treat patients with neurogenic detrusor overactivity secondary to spinal cord injury

English Keywords:【Key words】 Neurogenic detrusor overactivity  Spinal cord injury  Tibial nerve stimulation  Surface electrodes  Bladder capacity

English Abstract:

  【Abstract】 Objectives: To investigate the inhibitory effect of percutaneous tibial nerve stimulation(PTNS) by using adhesive skin surface electrodes in patients with neurogenic detrusor overactivity(NDO) secondary to spinal cord injury(SCI). Methods: From June 2013 to April 2014, 23 patients(19 males and 4 females) with NDO secondary to SCI underwent PTNS(Bladder-Pelvic Stimulator developed by Neural Electro-Mechanics Center of Chinese Academy Sciences and Department of Urology of China Rehabilitation Research Center) using adhesive skin surface electrodes. Among them, there were 3 patients with cervical spinal cord injury, 15 patients with thoracic spinal cord injury and 5 patients with lumbar spinal cord injury. 18 cases presented with complete spinal cord injury and 5 cases were incomplete spinal cord injury. All patients received PTNS twice a week for 4 weeks. Before the treatment, 2 and 4 weeks after the treatment respectively, patients were asked to keep 3-day bladder diaries and the quality of life was evaluated by patient perception of bladder condition scale(PPBC-S). Bladder diaries included the CIC times, volume per catheterization and the total leakage volume per day. During the period of the bladder diary entries, the patients were asked to maintain a consistent volume of fluid intake. The patients were also asked about any other unanticipated adverse event during treatment. Results: All the patients completed treatment, and no unanticipated adverse events were reported. Compared with baseline, after stimulation for 2 weeks, the volume per catheterization increased from 258.7±14.7ml to 282.5±15.2ml(P<0.05), the total leakage volume per day decreased from 766.4±61.5ml to 563.3±45.4ml(P<0.05), and the PPBC-S improved from 5.2±0.1 to 4.6±0.1(P<0.05). Four weeks later, the volume per catheterization was 294.1+15.4ml, the total leakage volume per day was 541.4±47.5ml, and PPBC-S was 4.4±0.1. All indexes improved significantly compared with baseline(P<0.05), but similar to the data 2 weeks after treatment(P>0.05). Before treatment, 2 and 4 weeks after treatment, the CIC frequency was 4.3±0.3, 4.1±0.3 and 4.0±0.2 respectively(P>0.05). No unanticipated adverse events were reported. Conclusions: Tibial nerve stimulation with adhesive skin surface electrodes can inhibit detrusor overactivity, increase bladder capacity and decrease leakage volume in patients with NDO secondary to SCI.