Int Neurourol J.  2019 Sep;23(3):249-256. 10.5213/inj.1938120.060.

Feasibility of Self-administered Neuromodulation for Neurogenic Bladder in Spinal Cord Injury

• Stampas A
• Khavari R
• Frontera J
• Groah SL

• KMID: 2460738
• DOI: http://doi.org/10.5213/inj.1938120.060

Abstract

PURPOSE
To determine if self-administered transcutaneous tibial nerve stimulation (TTNS) is a feasible treatment option for neurogenic bladder among people with spinal cord injury (SCI) who utilize intermittent catheterization for bladder management.
METHODS
Four-week observational trial in chronic SCI subjects performing intermittent catheterization with incontinence episodes using TTNS at home daily for 30 minutes. Those using anticholinergic bladder medications were given a weaning schedule to begin at week 2. Primary outcomes were compliance and satisfaction. Secondary outcomes included change in bladder medications, efficacy based on bladder diary, adverse events, and incontinence quality of life (I-QoL) survey.
RESULTS
All 16 subjects who started the study completed the 4-week trial rating TTNS with high satisfaction and easy to use, without discomfort. Twelve of 14 patients (86%) using anticholinergic bladder medications reduced their dosage and maintained similar frequency and volumes of bladder catheterization and incontinence episodes. Bladder medication reduced by approximately 3.2 mg weekly (95% confidence interval, -5.9 to -0.4) and anticholinergic side effects of dry mouth and drowsiness decreased more than 1 level of severity from baseline (P=0.027, P=0.015, respectively). At 4 weeks, total I-QoL score improved by an average of 3.2 points compared to baseline in all domains.
CONCLUSIONS
This pilot trial suggests TTNS is feasible to be performed at home in people with chronic SCI. Participants were able to reduce anticholinergic medication dosage and anticholinergic side effects while maintaining continence, subsequently improving QoL scores. These results advocate for further randomized, controlled trials with longer duration and urodynamic evaluation to assess long-term efficacy.

Keyword

Spinal cord injuries; Neuromodulation; Neurogenic bladder; Transcutaneous electric stimulation; Anticholinergic

MeSH Terms

Appointments and Schedules
Catheterization
Catheters
Compliance
Humans
Mouth
Quality of Life
Sleep Stages
Spinal Cord Injuries*
Spinal Cord*
Tibial Nerve
Transcutaneous Electric Nerve Stimulation
Urinary Bladder
Urinary Bladder, Neurogenic*
Urodynamics
Weaning