Inhibitory effects of a minimally invasive implanted tibial nerve stimulation device on non-nociceptive bladder reflexes
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UROLOGY - ORIGINAL PAPER
Inhibitory effects of a minimally invasive implanted tibial nerve stimulation device on non‑nociceptive bladder reflexes in cats Xiaoping Wan1,2,3,4 · Yanan Liang1,2,3,4 · Xing Li1,2,3,4 · Limin Liao1,2,3,4 Received: 1 July 2020 / Accepted: 21 September 2020 © Springer Nature B.V. 2020
Abstract Objective The present study investigated the inhibitory effects of a novel minimally invasive implanted tibial nerve stimulation device on non-nociceptive bladder reflexes in cats. Materials and methods A wireless minimally invasive implanted nerve stimulator was implanted adjacent to the left tibial nerve in seven cats. Multiple cystometrograms (CMGs) were obtained to determine the inhibitory effects of tibial nerve stimulation (TNS) at different frequencies and intensities on the micturition reflex by infusing normal saline (NS). Results TNS at 6 Hz did not significantly change the bladder capacity (BC) compared to the control level at the intensity threshold (T), while TNS significantly (P 0.05) change the BCs at 1 T and 2 T. Conclusions The minimally invasive implanted TNS device was shown to be effective in inhibiting the micturition reflex under physiologic conditions. Further studies are warranted to determine the inhibitory effects of TNS on nociceptive bladder reflexes. Keywords Stimulator · Tibial nerve stimulation · Implantable · Micturition reflex · Cats
Introduction An overactive bladder (OAB) is a common chronic urologic problem and is defined by the International Continence Society (ICS) as “urgency, usually with frequency and nocturia, with or without urge incontinence” [1]. It has been estimated that there approximately 20% of the population worldwide is affected by OAB [2, 3]. OAB seriously impacts a patient’s
* Xing Li [email protected] * Limin Liao [email protected] 1
Department of Urology, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing 100068, China
2
Department of Urology, Capital Medical University, Beijing 100068, China
3
Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing 100068, China
4
Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing 100068, China
quality of life and imposes an economic burden on society in different countries [4–8]. The tibial nerve (TN), as a peripheral nerve, has projections to the S2–S3 sacral segment, which forms part of the sacral nervous plexus and contains efferent and afferent nerve fibers related to bladder function [9]. Tibial nerve stimulation (TNS) has been recommended as a third-line treatment for managing OAB [10] and is considered to be a less invasive choice for OAB patients compared with sacral nerve stimulation (SNS) [11, 12]. Many studies have demonstrated that TNS has inhibitory effects on OAB at 5–30 Hz in animals [13, 14]. The frequency of TNS used in clinical settings is 5–20 Hz; however, traditional TNS requires at least 12 weeks of therapy in medical institutions. In addition, transcutaneous tibial nerve stim
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