Doherty, Sean Patrick; (2019) Investigation of Transcutaneous Neuromodulation Techniques and Development of a Wearable Device for Control of the Bladder following Spinal Cord Injury. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Spinal Cord Injury (SCI) causes unwanted and uncontrolled bladder contractions (NDO). Urological management goals are to protect the upper urinary tract and eliminate incontinence. Neuromodulation is a potential treatment that may accomplish this using transcutaneous electrical stimulation. Surface stimulation of the Dorsal Genital Nerve (DGNS), Tibial Nerve (TNS), Sacral Nerves (SNS) and Spinal Cord (SS) was studied in two experiments. Five participants with no SCI received stimulation at each site and anal sphincter EMG was recorded. In 4/5 DGNS evoked a reflex response, in 2/5 SNS evoked a short latency response and in 2/5 a reflex response to TNS was recorded at 1.5 x and 1.8 x the latency of participants DGNS responses. Seven participants with SCI and NDO trialled stimulation of the four sites during cystometry. Only DGNS significantly (p=0.016) increased bladder capacity by 153±146 ml and suppressed 2 ±2 detrusor contractions. Maximum Detrusor Pressure was significantly increased by TNS only, by 10±13 cmH₂O. DGNS, TNS and SNS all significantly increased to volume from first detrusor contraction to the maximum capacity. To assess existing bladder sensation, 313 urodynamic records were analysed. 77% were found to have preserved sensation, including 45% of those with complete injuries. Of those with supra-sacral SCI, 75% reported sensation, of whom approximately 86% could replicate this during urodynamic investigation. Five participants trialled DGNS during Ambulatory Urodynamic Monitoring (AUM) and over a week at home. During AUM, self-triggered simulation was used in 4/5 and both intermittent and continuous stimulation was trialled in 1/5. DGNS significantly increased bladder capacity (p=0.008), decreased MDP (p=0.016) and decreased average peak detrusor pressure (p=0.016) from baseline. Void volumes recorded in a bladder diary did not change significantly (p=0.250), nor did ICIQ scores. All participants continued existing antimuscarinic regimes, therefore improvements were in addition to existing medication.

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