URINARY-BLADDER CONTROL BY ELECTRICAL-STIMULATION - REVIEW OF ELECTRICAL-STIMULATION TECHNIQUES IN SPINAL-CORD INJURY

Evacuation of urine in paraplegics without the need for catheters woul d be possible when voiding could be induced by eliciting a bladder con traction. A challenging option to obtain detrusor contraction is elect rical stimulation of the detrusor muscle or its motor nerves. This art icle reviews the 4 possible stimulation sites where stimulation would result in a detrusor contraction: the bladder wall, the pelvic nerves, the sacral roots, and the spinal cord. With respect to electrode appl ication, sacral root stimulation is most attractive. However, in gener al, sacral root stimulation results in simultaneous activation of both the detrusor muscle and the urethral sphincter, leading to little or no voiding. Several methods are available to overcome the stimulation- induced detrusor-sphincter dyssynergia and allow urine evacuation. The se methods, including poststimulus voiding, fatiguing of the sphincter , blocking pudendal nerve transmission, and selective stimulation tech niques that allow selective detrusor activation by sacral root stimula tion, are reviewed in this paper. (C) 1997 Wiley-Liss, Inc.