The Effectiveness of Early Sacral Nerve Stimulation in Improving Bladder-Related Complications and Quality of Life after Acute Traumatic Spinal Cord Injury
Abstract
This proposal is directed at improving bladder function and quality of life following spinal cord injury (SCI). Nearly 250,000 people living in the United State have suffered a SCI and approximately one in five are Veterans or active Service members. Spinal trauma was present in 11% of all injuries sustained by military personal deployed to Iraq and Afghanistan, with 9% of those involving significant SCI. Patients who develop a neurogenic bladder (NGB) following SCI require assistance to empty their bladder. Methods for emptying the bladder include clean intermittent catheterization (CIC) or an indwelling catheter. Urinary dysfunction and incontinence have a significant clinical, physical, and quality of life (QOL) burden in patients with SCI, and it is consistently described as the most influential factor affecting their QOL. Inappropriate bladder management can cause significant complications including recurrent urinary tract infections, sepsis, and progressive kidney damage due to chronic urinary retention (high bladder volumes). As a result, 42% of SCI patients are hospitalized each year due to urinary problems. Following SCI, changes in the neurologic control of bladder are irreversible and only the symptoms can be treated. Specifically, the bladder becomes spastic and overly reactive, resulting in an inability to easily stretch to accommodate filling with urine. This creates high bladder pressures and frequent contractions that cause urinary incontinence and can lead to deterioration of kidney function. Standard management in SCI patients with NGB relies on the use of medications and clean intermittent catheterization in order to re-establish a low-pressure system and prevent episodes of incontinence, renal deterioration, and recurrent urinary infections. If patients fail these less invasive treatments, surgical bladder augmentation or a urostomy may be required, which has significant morbidity. Interventions during the acute phase of SCI aimed at ameliorating NGB remain understudied. Sacral nerve stimulation or sacral neuromodulation (SNM) is an established treatment, which is currently Food and Drug Administration-approved for the treatment of non-SCI urinary urge incontinence, frequency, and urinary retention. In SNM, an electrode is implanted in the sacral S3 nerve root and a small electrical pulse generator is implanted under the skin similar to a cardiac pacemaker. Preliminary animal and human research has demonstrated that SNM initiated immediately following SCI may prevent the development of many of the adverse consequences of NGB, improving bladder dynamics (namely bladder storage capacity and bladder spasms, which cause incontinence), and reduce the number of urinary tract infections patients experience. Changes in bladder storage capacity may seem inconsequential, but they actually translate to significant improvements in QOL. For instance, patients with a normal bladder capacity of 500 ml need to be perform CIC 4-5 times a day in contrast to patients with NGB and half that capacity who have to perform CIC 8-10 times daily and usually once during the night. CIC is not easy due to the physical impairments that accompany SCI, and lengthening the period between catheterizations results in improvement in independence and the ability to participate in social and other life activities. Patients who maintain a good bladder capacity, and low pressures, also do not leak from bladder spasms. The objective of our research is to evaluate the ability of SNM to improve bladder function, QOL, and reduce complications in post-SCI NGB. We propose randomizing 60 patients over a 2-year period to SNM versus standard management with the following aims to be evaluated at 1 year post-SCI: (1) To determine the effectiveness of SNM on improving bladder function. (2) To assess the impact of SNM on improving QOL after traumatic SCI. (3) To examine the ability of SNM to reduce clinical complications such as
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610688
Entities
People
- Jeremy Myers
Organizations
- United States Army
- University of Utah