Editorial

Intravesical electrical stimulation of the bladder: pro

Intravesical electrical stimulation (IVES) has been performed for various purposes in children with a neurogenic bladder. We evaluated the results of IVES on urodynamic study parameters in children with spina bifida.

We retrospectively analyzed the cases of 88 children who received IVES between August 1999 and May 2010 and whose comparative urodynamic data were available before and after treatment. According to the pre-IVES urodynamic study, children were divided into 3 groups: detrusor overactivity, detrusor underactivity and acontractile detrusor. We investigated the changes in detrusor function, bladder capacity and detrusor-sphincter dyssynergia.

In the group showing detrusor overactivity, the bladder had a synergic pattern in 41.7%, and normal detrusor function was observed in 16.7% of them. Bladder capacity increased after IVES therapy, especially in those who started therapy before 18 months of age (p = 0.019). Detrusor-sphincter dyssynergia was resolved in 55.6%. In the acontractile detrusor group, detrusor contraction ability increased in 48%, but bladder capacity did not.

Appropriate candidates for this treatment need to be carefully selected.

The management of urinary tract dysfunction is crucial for the health and well-being of people with spinal cord injury. Devices, specifically catheters, play an important role in the daily regime of bladder management for most people with spinal cord injury. However, the high incidence of complications associated with the use of catheters, and the fact that the spinal segments involved in lower urinary tract control remain intact in most cord-injured people, continue to motivate research into devices that could harness the nervous system to provide greater control over lower urinary tract function. Mechanical devices discussed in this review include catheters, artificial urethral sphincters, urethral stents and intraurethral pumps. Additionally, many attempts to restore control of the lower urinary tract with electrical stimulation have been made. Stimulation sites have included: inside the bladder, bladder wall, thigh, pelvic floor, dorsal penile nerve, pelvic nerve, tibial nerve, sacral roots, sacral nerves and spinal cord. Catheters and sacral root stimulators are two techniques whose efficacy is well established. Some approaches have proven less successful and others are still in the development stage. Modifications to sacral root stimulation including posterior root stimulation, anodal blockade and high-frequency blockade as well as new techniques including intraspinal microstimulation, urethral afferent stimulation and injectable microstimulators are also discussed. No single device has yet restored the control and function of the lower urinary tract to the pre-injury state, but new techniques are bringing this possibility closer to reality.