Article

OBJECTIVES: Electrical stimulation of the dorsal
genital nerves (DGN) suppresses involuntary detrusor contractions (IDCs) in
patients with neurogenic detrusor overactivity (DO). The feasibility of minimal
invasive electrode implantation near the DGN and the effectiveness of conditional
stimulation to suppress IDCs at different amplitudes in spinal cord injury (SCI)
patients with DO were studied. SETTING: Radboud University Nijmegen MC, The
Netherlands. METHODS: In eight healthy volunteers, a needle electrode was
inserted from both a medial and lateral-to-midline site at the level of the pubic
bone. Electrode insertion was guided by the genito-anal reflex (GAR) evoked by
electrical stimulation and by sensation to this stimulation. In eight SCI
patients with DO, the bladder was repeatedly filled and emptied partially in
between. Conditional stimulation using a needle electrode was applied when an IDC
was observed at urodynamics. Different amplitudes were used during each filling.
Control cystometry was carried out before electrode insertion and after
stimulation. RESULTS: The lateral implant approach was preferred, as it was
easier to manoeuvre the needle along the pubic bone and fixate the needle. In SCI
patients, the electrode was positioned successfully, and IDCs were suppressed
(range 1-6 IDC suppressions) with conditional stimulation at maximum tolerable
amplitude, except for one patient. Stimulation was less effective at lower
amplitudes. Stimulation lowered the intensity of bladder sensations concomitant
with IDC. CONCLUSION:
The lateral-to-midline implant approach, in combination
with GAR and sensation to stimulation, is feasible for electrode implantation
near the DGN in SCI patients. Conditional stimulation effectively suppresses IDCs.

Langue : ANGLAIS