Lumbosacral spinal cord epidural stimulation improves voiding function after human spinal cord injury

Area of Science:

• Neuroscience
• Urology
• Rehabilitation Medicine

Background:

• Spinal cord injury (SCI) frequently causes significant urologic dysfunction, impacting bladder storage and emptying.
• Current management for SCI-related urologic issues often involves lifelong side effects.
• There is a need for innovative therapies to restore bladder function after SCI.

Purpose of the Study:

• To investigate the efficacy of spinal cord epidural stimulation (scES) for improving bladder control in individuals with SCI.
• To identify optimal scES parameters for achieving reflexive bladder emptying.

Main Methods:

• A bladder mapping study was conducted over 16 sessions in an individual with chronic, motor complete SCI.
• Electrode configurations and stimulation frequencies were systematically tested during filling cystometry.
• Optimal parameters were validated in four additional participants.

Main Results:

• An effective scES configuration for reflexive bladder emptying was identified using caudal electrodes.
• A stimulation frequency of 30 Hz minimized post-void residual volumes.
• The identified parameters improved reflexive voiding efficiency in all tested participants.

Conclusions:

• Spinal cord epidural stimulation demonstrates significant potential for restoring urologic function after SCI.
• scES may enhance central nervous system excitability, enabling control over various bodily functions, including bladder management.
• These findings support scES as a promising therapeutic approach for SCI-related bladder dysfunction.