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

Int Neurourol J, 2019 · DOI: https://doi.org/10.5213/inj.1938120.060 · Published: September 30, 2019

Simple Explanation

This study investigates whether people with spinal cord injuries can use a device at home to stimulate a nerve in their leg, which might help with bladder control. This could be a new way to manage bladder problems without as many side effects as current medications. The researchers checked if the participants could easily use the device, if they were happy with it, and if it helped them reduce their bladder medications. They also looked at any side effects and changes in their quality of life. The results showed that the participants could use the device at home and were satisfied with it. They were also able to reduce their bladder medications and had fewer side effects, which improved their quality of life.

Study Duration

4 weeks

Participants

16 subjects with chronic SCI

Evidence Level

Pilot trial

Key Findings

1
All 16 subjects who started the study completed the 4-week trial rating TTNS with high satisfaction and easy to use, without discomfort.
2
Twelve of 14 patients (86%) using anticholinergic bladder medications reduced their dosage and maintained similar frequency and volumes of bladder catheterization and incontinence episodes.
3
At 4 weeks, total I-QoL score improved by an average of 3.2 points compared to baseline in all domains.

Research Summary

This pilot trial explored the feasibility of self-administered transcutaneous tibial nerve stimulation (TTNS) for managing neurogenic bladder in individuals with spinal cord injury (SCI). The study demonstrated high compliance and satisfaction among participants, with most able to reduce their anticholinergic medication dosage while maintaining continence. The findings suggest that TTNS is a promising nonpharmacologic alternative that warrants further investigation through randomized, controlled trials with longer duration and urodynamic evaluation.

Practical Implications

Home-Based Therapy

TTNS can be performed at home, offering a readily available and inexpensive treatment option for individuals with mobility impairments.

Reduced Medication Burden

TTNS allows for the reduction of anticholinergic medication dosage, minimizing the associated side effects and potential long-term risks such as dementia.

Improved Quality of Life

By maintaining continence with reduced medication and side effects, TTNS can improve the overall quality of life for individuals with SCI and neurogenic bladder.

Study Limitations

1
Lack of a sham-control group
2
Urodynamic outcome measures were not included, limiting conclusions on efficacy outcomes
3
Small number of participants and short duration of intervention

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