Deficits in urological function after spinal cord injury (SCI) include neurogenic detrusor overactivity and uncoordinated bladder and external urethral sphincter contractions, resulting in inefficient emptying and high intravesical pressure. Urinary retention and an inability of the bladder to store urine under appropriately low pressures can lead to infection and ultimately impact renal health. Current therapeutic approaches aim to manage both the storage and voiding phases of bladder function and include intermittent catheterization, pharmacologic and surgical interventions, as well as urethral stents. While most of these strategies are necessary for urological maintenance post-injury they oftentimes are associated with dose-limiting side effects and therefore remain inadequate. Neuromodulation has also been implemented in various formats as a promising alternative treatment for neurogenic bladder in an effort to regain control of function after SCI. Thus, this study investigated bladder outcomes in AIS grade A and B subjects receiving spinal cord epidural stimulation (scES) at L1-S1 spinal levels in combination with locomotor and/or stand training by our research team at the University of Louisville Human Locomotion Research Center. Urodynamic assessments were performed at pre- and post-training time-points and cystometrograms were captured with and without the use of scES. In addition, specific configurations and parameters optimal for continence and micturition were identified in several subjects during filling cystometry. We found that while locomotor training resulted in improvements in bladder capacity and voiding efficiency, the use of scES further enhanced these parameters and in a frequency-dependent manner. Importantly, as capacity increased, bladder pressures continued to remain low, indicating better compliance. Overall, scES may help contribute to an improvement in quality of life by providing a means of extending the time to catheterization under safe pressures and restoring efficient bladder emptying, ultimately preserving lower and upper urinary tract health.
*C. HUBSCHER1, A. HERRITY2, L. MONTGOMERY1, A. WILLHITE2, C. ANGELI2, S. HARKEMA2;
1Dept Anatom. Sci. & Neuro, Univ. Louisville Sch. Med., Louisville, KY; 2KSCIRC, Frazier Rehab Inst., Louisville, KY
C. Hubscher: None. A. Herrity: None. L. Montgomery: None. A. Willhite: None. C. Angeli: None. S. Harkema: None.