Improved sacral neuromodulation in the treatment of the hyperactive detrusor: signal modification in an animal model.

Abstract:

OBJECTIVE:To investigate different stimulation signals for the peripheral nerve evaluation test (PNE, carried out before implanting a sacral neuromodulator for functional voiding dysfunction) in an animal model and to determine their efficacy, as up to 80% of patients do not respond to the PNE test. MATERIALS AND METHODS:PNE foramen electrodes were placed in the S3 of 12 anaesthetized Göttingen minipigs. First, detrusor instabilities were induced by the intravesical instillation of formalin. A 10-min stimulation phase with both a quasi-trapezoidal (QT) signal and a rectangular signal followed. An interval of 30 min elapsed between the series of stimulations. The attained bladder pressure values were registered on a urodynamic unit and evaluated as contractions and amplitudes per minute. Six minipigs were treated in the same way but were not stimulated and served as a control group. RESULTS:After formalin instillation, the mean (sd) number of involuntary detrusor contractions was 3.5 (0.8)/min and the sum of amplitudes 7.2 (1.1) cmH2O/min. Subsequent NaCl instillation and QT-stimulation reduced the contractions to 0.3 (0.3)/min and the sum of amplitudes to 0.8 (0.4) cmH2O/min. Stimulation with a rectangular signal, as used in the PNE test, followed after an interval of 10 min, giving 1.1 (0.1) contractions/min and a sum of amplitudes of 5.1 (2.4) cmH2O/min. Within the control group there was no significant reduction. CONCLUSIONS:These results show that QT-stimulation suppresses uncontrollable detrusor contractions in the minipig more effectively than the conventional rectangular stimulation presently applied in sacral neuromodulation.

journal_name

BJU Int

journal_title

BJU international

authors

Seif C,Cherwon E,Martinez Portilló FJ,Alken P,Jünemann KP,Braun PM

doi

10.1046/j.1464-410x.2003.04185.x

keywords:

subject

Has Abstract

pub_date

2003-05-01 00:00:00

pages

711-5

issue

7

eissn

1464-4096

issn

1464-410X

pii

4185

journal_volume

91

pub_type

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