Effectiveness Of Neuromuscular Electric Stimulation In The Treatment Of Neurogenic Bladder In Patients With Spinal Cord Injury

BACKGROUNDSpinal cord injury(SCI) may result in tetraplegia or paraplegia,which is a great damage to the abilities of patients daily living.The complications of SCI affect not only the rehabilitation treatment,but also quality of the patients' living;even threaten to patiens'life,especially complication of urinary system.The most common causes of death after a spinal cord injury are renal failure and urinary tract infection in our county.In the recovery period of SCI,patients suffered from urinary dysfunction,for example:micturition,urgency,the volume of residual urine after voiding increased, urinary incontinence,et cal.So improve these symptoms is very important for those patients to enhance their social confidence,improve their quality of life and extend their life expectancy.Pelvic floor electrical stimulation(PFES) is a technique which stimulates the pelvic floor muscles through anal or vaginal electrodes by intermittent current,thus causing urethral closure.It is a way of functional electrical stimulation.Women choose vaginal electric stimulation,men choose anal electric stimulation.It has reported that PFES could treat urination dysfunction,and has a good effect to female stress urinary incontinence,urge incontinence and mixed urinary incontinence also.It has reported that sacral surface therapeutic electrical nerve stimulation(SS-TENS) could significantly improve the maximum capacity of bladder and reduce bladder no suppression contraction for patients with urinary incontinence.However,it is rarely reported that SS-TENS combine PFES affect the neurogenic bladder function after SCI.OBJECTIVETo observe the therapeutic effects of sacral surface therapeutic electrical nerve stimulation(SS-TENS) and pelvic floor electrical stimulation(PFES) on neurogenic bladder in patients with spinal cord injury(SCI).METHODSThis trial selected 30 inpatients with neurogenic bladder after SCI who hospitalized Rehabilitative Medicine Department of Nan Fang hospital,Southern Medical University.Among them 13 patients from January 2007 to January 2008 as the control group.They were 12 males and 1 female,with an average age of 36.85±7.65 years old(from 20 to 52 years old).The duration of disease in these patients were ranged from 2 months to 6 months,with an average of 4.23±1.17 months.All patients were given conventional rehabilitation therapy and bladder training for 4 weeks.The changes of the ASIA scores and urinate dairy,before and after treatment were record.Another 17 patients from January 2008 to January 2009 as the test group.They were 15 males and 2 females, with an average age of 33.29±13.08 years old(from 19 to 59 years old).The duration of disease in these patients were ranged froml month to 7 months,with an average of 4.00±1.63 months.All patients were given conventional rehabilitation therapy and bladder training for 4 weeks.During this period they were treated with SS-TENS and PFES for 20 min once a day,5 days a week.The changes of the ASIA scores,urinate dairy and urodynamic investigation before and after treatment were record.STATISTICAL METHODSThe statistical analysis was performed with SPSS13.0 software package and the data were presented with(Mean±Standard Deviation).Statistical significance was set at P＜0.05.Comparisons of the clinical baseline between the tow group before treatment were performed using Fisher probabilities in 2×2 table, independent-samples t-test.Comparisons of the urinate dairy between the tow group before and after treatment were analyzed with the repeated measure ANOVA. Comparisons of the ASIA scores in every group before and after treatment were performed using paired t-test;Comparisons of the urodynamic investigation in the test group before and after treatment were performed using paired t-test.RESULTSA total of 29 patients were completed in the whole trial.There was 1 patient dropt out because of perianal discomfort in the test group.1.Comparisons of the clinical baseline between the tow groups:There were no significant difference between the control group and test group on the clinical baseline(include age,duration of disease,degree of SCI and urinate dairy)(P＞0.05).2.Comparisons of the ASIA scores in every group before and after treatment:There was no significant difference in the control group on the ASIA scores before and after treatment(P＞0.05);There was no significant difference in the test group on the ASIA scores before and after treatment(P＞0.05);3.Comparisons of the urinate dairy between the tow groups before and after treatment:3.1 The average frequency of urination per 24h:There was interaction effect between group and time.(F=23.282, P=0.000).Analyzing from single effect,there was significant difference on time after treatment(P=0.000).In test group the average frequency of urination a day was from 11.29 down to 6.42,decreased 4.87,but in control group the average frequency of urination a day was from 10.95 down to 7.82,decreased 3.13,The test group decrease the average frequency of urination a day is better than the control group.3.2 Average volume of each urine:There was interaction effect between group and time.(F=18.484,P=0.000). Analyzing from single effect,there was significant difference on time after treatment (P=0.000).In test group the average volume of each urine was from 115.94ml to 187.95ml,increased 72.01ml,but in control group the average volume of each urine was from 121.21ml to 162.20,increased 40.99ml,The test group increase the average volume of each urine is better than the control group.3.3 Average residual urine:There was interaction effect between group and time.(F=5.237, P=0.030).Analyzing from single effect,there was significant difference on time after treatment(P=0.030).In test group the average residual urine was from 142.14ml down to 90.54ml,decreased 51.60ml,but in control group the average residual urine was from 140.82ml down to 112.36ml,decreased 28.46,The test group decrease the average residual urine is better than the control group.3.4 Average frequency of urinary incontinence per 24h:There was interaction effect between group and time.(F=16.146, P=0.000).Analyzing from single effect,there was significant difference on time after treatment(P=0.000).In test group the average frequency of urinary incontinence a day was from 7.48 down to 2.86,decreased 4.62,but in control group the average frequency of urinary incontinence a day was from7.16 down to 3.99,decreased 3.17, The test group decrease the average frequency of urinary incontinence a day is better than the control group.4.Comparisons of the urodynamic investigation in test group before and after treatment:The results of urodynamic investigation in test group showed that maximum cystometric capacity was significantly increased(P=0.000),max urethal pressure was significantly increased(P=0.000),detrusor pressure at retention was significantly decreased(P=0.000).CONCLUSIONS1.Conventional rehabilitation therapy and bladder training could improve the function of neurogenic bladder in patients with spinal cord injury;they could decrease the average frequency of urinary incontinence and urination per 24h,decrease the average residual urine and increase the average volume of each urine. 2.SS-TENS and PFES could enhance the therapeutic effects of conventional rehabilitation therapy and bladder training to the function of neurogenic bladder in patients with spinal cord injury.3.SS-TENS and PFES could improve the function of neurogenic bladder in patients with spinal cord injury;they could decrease the average frequency of urinary incontinence and urination per 24h,decrease the average residual urine and increase the average volume of each urine.4.To the neurogenic bladder in patients with spinal cord injury,SS-TENS and PFES combine conventional rehabilitation therapy and bladder training could increase the max urethal pressure and the maximum cystometric capacity,decrease the detrusor pressure at retention.