Research Progress of Acupuncture Treatment of Neurogenic Bladder after Spinal Cord Injury

Neurogenic bladder (NB) mainly occurs in patients with spinal cord injury (SCI). The pathological basis of NB is the occurrence of lesions in the urination control center, which requires systematic treatment. Western medicine has many treatment methods for this disease, which can alleviate the symptoms of the disease. However, the radical effect is not ideal and there are many adverse reactions. In comparison, acupuncture can improve the residual urine volume of NB patients and regulate the related indexes of urodynamics. There are many kinds of acupuncture therapies, such as simple acupuncture and moxibustion, which can comprehensively improve the therapeutic effect and obtain a better disease prognosis. Therefore, this article elaborates on the pathogenesis of SCI complicated with NB, the treatment mechanism, and treatment methods of acupuncture and moxibustion to provide a reference for clinical treatment.

Rehabilitation care of patients with neurogenic bladder after spinal cord injury:A literature review

This article reviews the research progress of rehabilitation treatment and nursing care of patients with neurogenic bladder after spinal cord injury,in order to provide reference for the rehabilitation treatment and nursing care of patients.We reviewed recent medical literature on patients with neurogenic bladder,focusing on neurogenic bladder caused by spinal cord injury.We analyzed 30 recent of publications in patients with neurogenic bladder after spinal cord injury,in addition to reviewing and evaluating the commonly used rehabilitation nursing methods for neurogenic bladder.Psychological counseling is a vital aspect which cannot be neglected in the process of neurogenic bladder rehabilitation.Hitherto,the commonly used drug and surgical treatments may have negatively impacted the mental health of patients in varying degrees.However,in clinical practice,applying intermittent catheterization in patients who have neurogenic bladder with spinal cord injury may help improve patients’life quality,mitigate psychological burden,and reduce negative emotions.

Long-term anodal block stimulation at sacral anterior roots promoted recovery of neurogenic bladder function in a rabbit model of complete spinal cord injury

A complete spinal cord injury model was established in experimental rabbits using the spinal cord clip compression method. Urodynamic examination was performed 2 weeks later to determine neurogenic bladder status. The rabbits were treated with anodal block stimulation at sacral anterior roots for 4 weeks. Electrical stimulation of sacral anterior roots improved urodynamic parameters of neurogenic bladder in rabbit models of complete spinal cord injury, effectively promoted urinary function, and relieved urinary retention. Immunohistochemistry results showed that a balance was achieved among expression of muscarinic receptor subunits M2, M3, ATP-gated ion channel P2X3 receptors, and 132-adrenergic receptor, and nerve growth factor expression decreased. These results suggested that long-term sacral anterior root stimulation of anodal block could＇be used to treat neurogenic bladder in a rabbit model of complete spinal cord injury.

Bibliometric profile of neurogenic bladder in the literature:a 20-year bibliometric analysis

Neurogenic bladder is a dysfunction of the lower urinary tract caused by nervous system disor- der. We investigated the trends in publication of articles under the topic ＂neurogenic bladder＂ using bibliometric analysis. Articles on neurogenic bladder, published between 1995 and 2014, were retrieved from the ISI Web of Science citation database. We analyzed the search results for authors, countries, institutions, journals, and top-cited papers. A total of 1,904 articles were re- trieved. There was a small increase in the number of articles on neurogenic bladder from 1995 （n = 43） to 2014 （n = 117）. The USA was the leading country in the total number of articles （n = 598）. However, the number of publications from China has rapidly increased, and China was ranked second in 2014. Emmanuel Chartier-Kastler （n = 65） was the most productive author, and University of Paris VI （Paris 6） （n = 61） was the most productive institution. The Journal of Urology published the greatest number of artides on this topic （n = 285）. Articles on neurogenic bladder were often published in a professional journal under the category Urology ＆ Nephrology, Neurosciences ＆ Neurology, or Rehabilitation. Visualization analysis based on co-citation networks was conducted using CiteSpace III. Visualization analysis revealed that the hot spots in neurogenic bladder were botulinum toxin-A, prazosin, bethanechol, and afferent pathways. These findings provide new insight into the publication trends and hot spots in neurogenic bladder.

Survey of spinal cord injury-induced neurogenic bladder studies using the Web of Science

OBJECTIVE：To identify global trends in research on spinal cord injury-induced neurogenic bladder, through a bibliometric analysis using the Web of Science. DATA RETRIEVAL：We performed a bibliometric analysis of studies on spinal cord injury-induced neurogenic bladder using the Web of Science.Data retrieval was performed using key words＂spinal cord injury＂,＂spinal injury＂,＂neurogenic bladder＂,＂neuropathic bladder＂,＂neurogenic lower urinary tract dysfunction＂,＂neurogenic voiding dysfunction＂,＂neurogenic urination disorder＂and ＂neurogenic vesicourethral dysfunction＂. SELECTION CRITERIA：Inclusion criteria：（a）published peer-reviewed articles on spinal cord injury-induced neurogenic bladder indexed in the Web of Science;（b）type of articles：original research articles and reviews;（c）year of publication：no limitation.Exclusion criteria：（a）articles that required manual searching or telephone access;（b）Corrected papers and book chapters. MAIN OUTCOME MEASURES：（1）Annual publication output;（2）distribution according to journals; （3）distribution according to subject areas;（4）distribution according to country;（5）distribution according to institution;and（6）top cited publications. RESULTS：There were 646 research articles addressing spinal cord injury-induced neurogenic bladder in the Web of Science.Research on spinal cord injury-induced neurogenic bladder was found in the Science Citation Index-Expanded as of 1946.The United States,Ireland and Switzerland were the three major countries contributing to studies in spinal cord injury-induced neurogenic bladder in the 1970s.However,in the 1990s,the United States,the United Kingdom,the Netherlands,Germany and Japan published more papers on spinal cord injury-induced neurogenic bladder than Switzerland,and Ireland fell off the top ten countries list.In this century,the United States ranks first in spinal cord injury-induced neurogenic bladder studies,followed by France,the United Kingdom,Germany,Switzerland and Japan.Subject categories including urology, nephrology and clinical neurology,as well as rehabilitation,are represented in spinal cord injury-induced neurogenic bladder studies. CONCLUSION：From our analysis of the literature and research trends,we conclude that spinal cord injury-induced neurogenic bladder is a hot topic that will continue to generate considerable research interest in the future.

Augmentation cystoplasty in children with stages III and IV chronic kidney disease secondary to neurogenic bladder

Objective:This study examines the outcome of augmentation cystoplasty(AC)in children with stages III and IV chronic kidney disease(CKD)secondary to neurogenic bladder in which transplantation was not imminent.Methods:Hospital records of all children with CKD stages III and IV who underwent AC between 2008 and 2017 were retrieved to study outcome and complications including estimated glomerular filtration rate(eGFR,National Kidney Foundation Calculator),somatic growth(percentiles,compared with population data),and febrile urinary tract infections(fUTIs)requiring admission.Statistical analysis was performed using R.Results:AC was performed in 13 children with CKD stages III and IV(10 girls;median 8.0 years)with median follow-up of 51 months.Patients had incontinence(10/13),reflux(7/13),and hydronephrosis(13/13)despite antimuscarinics and intermittent catheterization.Bladder capacity was 74%of expected and median compliance was 5 mL/cm H20(inter-quartile range 4 mL/cm H20).All underwent ileocystoplasty(25 cm bowel).One each had nephrectomy and mitrofanoff conduit.All had resolution of incontinence.One had acute kidney injury that recovered.Initial eGFR at presentation(24 mL/min/1.73 m2)improved with conservative management alone(52 mL/min/1.73 m2,p=0.004).This improved further 1 year following AC(61 mL/min/1.73 m2,p=0.036)with stable function at 7 years.There was improvement in somatic growth,hydronephrosis,and fUTI despite no ureteric re-implantation.Conclusion:AC carries acceptable morbidity in children with CKD stages III and IV secondary to neurogenic bladder.Surgery is effective with improvements in continence,eGFR,somatic growth,and propensity for fUTIs.Ureteric re-implantation might not be necessary.

Outcomes of seromuscular bladder augmentation compared with standard bladder augmentation in the treatment of children with neurogenic bladder

BACKGROUND Intestinal seromuscular bladder augmentation(SMBA)surgery has produced no mucosal-related complications,but its outcomes need to be studied.AIM To evaluate the safety and effectiveness of SMBA in the treatment of children with neurogenic bladder.METHODS A retrospective analysis of the clinical data of children with SMBA was performed from March 2008 to February 2018,and the data were compared with those of children receiving standard cystoplasty(SC).RESULTS In a cohort of 67 children who underwent bladder augmentation,the 46 children in the SC group had an average age of 10.6 years and a follow-up time of 36 mo,and the 21 children in the SMBA group had an average age of 7.6 years and a follow-up time of 29.7 mo.The preoperative and postoperative bladder volumes in the SMBA group were 151.7 mL and 200.4 mL,respectively,and those in the SC group were 173.9 mL and 387.0 mL,respectively.No significant difference in preoperative urinary dynamic parameters was found between the two groups,but the difference after operation was statistically significant.The main complications after SMBA were residual ureteral reflux and failed bladder augmentation,with incidences of 33.3%and 28.6%,respectively.In all 6 patients with failed augmentation in the SMBA group,ileum seromuscular patches were used for augmentation,and SC was chosen for reaugmentation.During reoperation,patch contracture and fibrosis were observed.CONCLUSION The improvement of urinary dynamic parameters in the SMBA group was significantly lower than that in the SC group.Children with SMBA had a higher probability of patch contracture and reaugmentation,which might be related to impaired blood supply and urine stimulation,and the sigmoid colon patch should be the priority.

Translation of basic science into clinical medicine in man-agement for neurogenic bladder

Neurogenic bladder （ NB） dysfunction caused by spinal cord injury （ SCI ） or diseases of the central nervous system or peripheral nerves is a major medical and social problem. Traditional treatments to NB include medication, injection of Botulinum toxin A into the detrusor, neuromodulation and surgery. There are also emerging approaches, such as tissue engineering, stem cell transplantation and gene therapy. In recent years, we have carried out explorations in both therapeutic areas and tried to translate basic research into clinical practice. This paper reviews our work in this regard, and provides references for future research.

Effects of electroacupuncture on urodynamics,intramedullary apoptosis and bidirectional regulation of neurotrophic factors in neurogenic bladder rats after supersacral spinal cord injury

Objective:To observe the effects of electroacupuncture on urodynamics and intramedullary apoptosis related factor B cell lymphoma gene-2(Bcl-2),Bcl-2 related protein X(Bax)and brain-derived neurotrophic factor(BDNF)in neurogenic bladder rats after supersacral spinal cord injury.Methods:A total of 60 female SD rats,SPF grade,were randomly selected,12 rats in the blank group and 12 rats in the sham operation group,and the remaining 36 rats were made models.Of these 36 rats,24 rats meeting the model standard were randomized into the model group and electroacupuncture group,with 12 rats in each group.The neurogenic bladder models after supracacral spinal cord injury were prepared by the Hassan Shaker spinal cord transection method,via combining the previous model study experience.At the end of spinal shock stage,"Dazhui(大椎GV14)""Zhongji(中极CV 3)""Ciliao(次髎BL 32)",and"Sanyinjiao(三阴交SP 6)"were selected for electroacupuncture.Observation on the histomorphological changes of bladder detrusor and spinal cord in rats was conducted by HE staining.The apoptosis rate of spinal cord cells was measured by TUNEL assay.The maximum bladder volume and compliance were measured by urodynamics test.The protein expressions of Bcl-2,Bax,and BDNF in spinal cord tissues were measured by Western blot assay.The expressions of Bcl-2,Bax,and BDNF mRNA were measured by RT-PCR assay.Results:(1)The results of HE staining showed that compared with the blank group and sham operation group,in the model group the bladder epithelial cell structure was destroyed,the detrusor muscle fibers proliferated,and there were severe bleeding changes,the spinal cord tissue was disordered,the structure was destroyed,the cell space was enlarged,and accompanied by a large number of inflammatory cell infiltration and cystic cavity formation.Compared with the model group,in the electroacupuncture group,the intact bladder epithelial cells increased,the detrusor muscle fiber proliferation decreased,the bleeding changes decreased,the complete structural area of spinal cord tissues increased,the cell space decreased,the levels were clearer,and the cystic cavity decreased.(2)The results of TUNEL assay indicated that the TUNEL positive rate of spinal cord cells in the model group was significantly higher than that in the blank group and sham group(both P<0.05).Compared with the model group,the TUNEL positive rate of spinal cord cells in the electroacupuncture group was significantly reduced(P<0.05).(3)The results of urodynamics test suggested that compared with the blank group and sham operation group,the maximum bladder volume and compliance of the model group were significantly reduced(all P<0.05).Compared with the model group,the maximum bladder volume and compliance were significantly increased in the electroacupuncture group(both P<0.05).(4)The results of Western blot assay indicated that,compared with the blank group and sham operation group,in the model group the protein contents of Bcl-2 and BDNF were significantly reduced(all P<0.05),while the protein content of Bax in the model group was significantly increased(both P<0.05).(5)The results of RT-PCR assay indicated that,compared with blank group and sham operation group,in the model group the intramedullary Bcl-2 and BDNF mRNA were significantly reduced(all P<0.05),and Bax mRNA was significantly increased(both P<0.05).Conclusion:Electroacupuncture at"GV14""CV3""BL32",and"SP6"can promote the repair of bladder detrusor,improve the maximum bladder volume and compliance of bladder,promote morphological repair of bladder detrusor,reduce spinal cord cell apoptosis rate,thus to restore the function of bladder.This is maybe related with the electroacupuncture’s two-way regulatory mechanism of increased expression of protein and gene of Bcl-2 and BDNF and decreased expression of protein and gene of Bax in spinal cord tissues.

Effect of Electroacupuncture on urodynamics, PACAP-38 and PAC1R of spinal cord in rats with neurogenic bladder

Objective： To investigate the effect and mechanism of electroacupuncture（EA） in the intervention of neurogenic bladder（NB） caused by suprasacral spinal cord injury（SCI）.Methods： The total 60 female Sprague-Dawley（SD） rats were divided into blank group, sham operation group by adopting random number table method, with 12 rats in each group. The remaining rats were made into models through operation, and 24 successful model rats were randomly divided into model group and EA group, with 12 rats in each group. Since the 19 th day after modeling, EA was conducted at ＂Cìliào＂（次髎BL 32）, ＂Zhōngjí＂（中极CV 3）,＂Sānyīnjiāo＂（三阴交SP 6） and ＂Dàzhuī＂（大椎GV 14） in EA group, remaining the needle for 20 min every time. The intervention was performed for once a day, and7 consecutive days were needed. The rest of the three groups were only tied up for the same time. Urodynamics test was conducted after the intervention. The contents of PACAP-38 and PAC1 R of the spinal cord of the injury site were detected by Western blot.Results： Compared with the blank group. there were no significant differences in the bladder capacity,leak point pressure, bladder compliance and PACAP-38 and PAC1 R contents in spinal cord in sham operation group; compared with the sham operation group, the maximum bladder capacity and the bladder compliance in the model group were lower（both P〈0.05）, the leak point pressure was higher（P〈0.05）,the contents of PACAP-38 and PAC1 R were lower（both P〈0.05）; compared with the model group, the maximum bladder capacity and the bladder compliance in the EA group were higher（both P〈0.05）, the leak point pressure was lower（P〈0.05）, the contents of PACAP-38 and PAC1 R were higher（both P〈0.05）.Conclusion： EA at BL 32, CV 3, SP 6 and GV 14 can improve the bladder function of NB rats of suprasacral SCI, and its mechanism may be related to the increase expression of PACAP-38 and PAC1 R protein in the injured spinal cord tissue.

The treatment of urinary retention of neurogenic bladder of one patient with diabetes from the perspective of governor vessel:A case report

Objective： To report the clinical effect of traditional acupuncture and moxibustion in the treatment of neurogenic bladder.Methods： A single case of a 57-year-old female with neurogenic bladder retention of urine considering governor vessel in the use of acupuncture and moxibustion. Acupoints selected： Shenshū（肾俞BL 23）,Pángguāngshū（膀胧俞 BL 28）. Yāoyángguan（腰阳关GV 3）, Mìngmén（命门 GV 4）. Moxibustion was applied on Guānyuán（关元 CV4） at the same time.Results： After 6 times of treatment, the patient’s urination function return to normal, avoid the adverse effect of retention catheterization.Conclusion： It is suggested that the combination of acupuncture and moxibustion, and the integration of syndrome differentiation and disease differentiation can effectively treat retention of urine due to neurogenic bladder of patient with diabetes.

A New Device for Intermittent Emptying of the Bladder in Children and Adults: A Long-Term Follow-Up

Contextualization: Emptying the bladder is a challenging problem for the urological community. Intermittent catheterization is the most widely used method to restore bladder emptying mechanism. However, this procedure can have a negative impact on self-image and result in a decline in the quality of life of patients. In this context, the use of a bladder emptying device (SVCATH3D) proposes to be effective and have a positive impact on the quality of life of different patients. Objective: The objective of the study was to evaluate the functionality of a new device for both intermittent and controlled emptying of the bladder in both sexes and ages. Materials and methods: A randomized clinical trial was conducted with 251 patients, with different bladder problems, from March 2013 to January 2023. After randomization, the patients were divided into two groups: Group I (SVCATH3D) and Group II (Clean Intermittent Catheterization). The primary outcome was defined as the impact on quality of life. Data on episodes of urinary tract infection, adverse effects, number of diaper use and treatment costs were analyzed. Results: The apposition of the SVCATH3D was performed on an outpatient basis, with no complications during the procedures. The patients were followed up for 10 years. There was a significant improvement in quality of life when comparing the moments before and after the use of SVCATH3D (p Conclusion: The study using SVCATH3D showed promising results in relation to functionality, showing improvement in quality of life with a reduction in episodes of urinary infection and amount of diapers/day. This allows us to conclude that SVCATH3D can represent an important step in the treatment of patients suffering from various bladder problems both incontinence and affecting emptying mechanism.

Electrophysiological monitoring and identification of neural roots during somatic-autonomic reflex pathway procedure for neurogenic bladder

OBJECTIVE: To identify and separate the ventral root from dorsal root, which is the key for success of the artificial somatic-autonomic reflex pathway procedure for neurogenic bladder after spinal cord injury (SCI). Here we report the results of intra-operating room monitoring with 10 paralyzed patients. METHODS: Ten male volunteers with complete suprasacral SCI underwent the artificial somatic-autonomic procedure under general anesthesia. Vastus medialis, tibialis anticus and gastrocnemius medialis of the left lower limb were monitored for electromyogram (EMG) activities resulted from L4, L5, and S1 stimulation respectively to differentiate the ventral root from dorsal root. A Laborie Urodynamics system was connected with a three channel urodynamic catheter inserted into the bladder. The L2 and L3 roots were stimulated separately while the intravesical pressure was monitored to evaluate the function of each root. RESULTS: The thresholds of stimulation on ventral root were 0.02 ms duration, 0.2-0.4 mA, (mean 0.3 mA+/-0.07 mA), compared with 0.2-0.4 ms duration, 1.5-3 mA (mean 2.3 mA+/-0.5 mA) for dorsal root (P

Surgical outcomes of bladder augmentation: A comparison of three different augmentation procedures

BACKGROUND Augmentation cystoplasty is indispensable in many pediatric diseases,especially neurogenic bladder.Various methods and materials are used to augment the bladder,and these methods are associated with different shortcomings and complications.AIM The present study reported the mid-term outcomes of patients undergoing various bladder augmentation procedures in a single institution,and assessed whether seromuscular cystoplasty lined with urothelium(SCLU)provided better urodynamic results than auto-augmentation(AA).METHODS A retrospective review of 96 patients undergoing various augmentation methods between 2003 and 2018 was performed.The patients were divided into three groups according to the type of augmentation,and their outcomes were compared.All patients developed neurogenic bladder due to myelomeningocele or sacrococcygeal teratoma.The clinical data of all patients were collected.RESULTS The mean ages at surgery in the three groups(standard cystoplasty[SC],SCLU,AA)were 10.8,7.5,and 4.8 years,respectively,with mean follow-ups of 36,61,and 36 mo,respectively.The mean preoperative and postoperative bladder capacities of the SC,SCLU,and AA groups were 174±11.7 vs.387±13.7(P<0.0001),165±12.2 vs.240±14.7(P=0.0002),and 138±16.7 vs.181±9.9(P=0.0360),respectively.Compared with the AA group,the SCLU procedure did not have better postoperative urodynamic parameters.Incontinence was reduced in most patients.The mean times of clean intermittent catheterization per day in the SC,SCLU,and AA groups were 5.6,7.8,and 8.2,respectively.The main complications of the SC group were recurrent urinary tract infections(8%)and bladder calculi(6%).Re-augmentation was done in patients in the SCLU(8)and AA(3)groups.CONCLUSION SC provided sufficient bladder capacity and improved compliance with acceptable complications.After AA and SCLU,the patients acquired limited increases in bladder capacity and compliance with a high rate of re-augmentation.Compared with AA,SCLU did not yield better postoperative urodynamic parameters.

The Assessment of Bladder and Urethral Function in Spinal Cord Injury Patients

The correlation between the anatomic site of spinal cord injury and real-time conditions of bladder and urethral function was assessed in order to provide a reasonable basis for the clinical treatment of neurogenic bladder. A total of 134 patients with spinal cord injuries （105 males, 29 females; averaged 34.1 years old） were involved in this retrospective analysis, including urodynamic evaluation, clinical examination and imaging for anatomical position, and Bors-Comarr classification. The associa- tions between the levels of injury and urodynamic findings were analyzed. The results showed that mean follow-up duration was 16.7 months （range 8-27 months）. Complete spinal cord injuries occurred in 21 cases, and incomplete spinal cord injuries in 113 cases. Of the 43 patients with upper motor neuron （UMN） injuries, hyperref/exia and （or） detrusor sphincter dyssynergia were demonstrated in 30 （69.8%）, 31 （72.1%） suffered low bladder compliance （less than 12.5 mL/cmH20）, 28 （65.1%） had high detrusor leak point pressures （greater than 40 cmH20）, and 34 （79.1%） had residual urine. Of the 91 patients with lower motor neuron （LMN） injuries, areflexia occurred in 78 （85.7%）, high compliance in 75 （82.4%）, low leak point pressures in 80 （87.9%）, and residual urine in 87 （95.6%）, respectively. The associations between the anatomical site of spinal cord injury and urodynamic findings were ill defined. In patients with spinal cord injury, this study revealed a significant association between the level of injury and the type of voiding dysfunction. The anatomical site of spinal cord injury can not be predicted in real-time condition of bladder and urethral function. Management of neurogenic bladder in patients with spinal cord injury must be based on urodynamic findings rather than inferences from the neurologic evaluation.

Electrical stimulation of dog pudendal nerve regulates the excitatory pudendal-to-bladder reflex

Pudendal nerve plays an important role in urine storage and voiding.Our hypothesis is that a neuroprosthetic device placed in the pudendal nerve trunk can modulate bladder function after suprasacral spinal cord injury.We had confirmed the inhibitory pudendal-to-bladder reflex by stimulating either the branch or the trunk of the pudendal nerve.This study explored the excitatory pudendal-to-bladder reflex in beagle dogs,with intact or injured spinal cord,by electrical stimulation of the pudendal nerve trunk.The optimal stimulation frequency was approximately 15–25 Hz.This excitatory effect was dependent to some extent on the bladder volume.We conclude that stimulation of the pudendal nerve trunk is a promising method to modulate bladder function.

Urinary bladder cancer as a late sequela of traumatic spinal cord injury

Background:Traumatic spinal cord injury(SCI)is also a combat-related injury that is increasing in modern warfare.The aim of this work is to inform medical experts regarding the different course of bladder cancer in able-bodied patients compared with SCI patients based on the latest medical scientific knowledge,and to present decision-making aids for the assessment of bladder cancer as a late sequela of traumatic SCI.Methods:A study conducted between January 1998 and December 2019 in the BG Trauma Hospital Hamburg formed the basis for the decision-making aids.Urinary bladder cancer was diagnosed in 40 out of 7396 treated outpatient and inpatient SCI patients.General patient information,latency period,age at initial diagnosis,type of bladder management and survival of SCI patients with bladder cancer were collected and analysed.T category,grading and tumor entity in these patients were compared with those in the general population.Relevant bladder cancer risk factors in SCI patients were analysed.Furthermore,relevant published literature was taken into consideration.Results:Initial diagnosis of urinary bladder cancer in SCI patients occurs at a mean age of 56.4 years(SD±10.7 years),i.e.,approximately 20 years earlier as compared with the general population.These bladder cancers are significantly more frequently muscle invasive(i.e.,T category≥T2)and present a higher grade at initial diagnosis.Furthermore,SCI patients show a significantly higher proportion of the more aggressive squamous cell carcinoma than that of the general population in areas not endemic for the tropical disease schistosomiasis.Consequently,the survival time is extremely unfavourable.A very important finding,for practical reasons is that,in the Hamburg study as well as in the literature,urinary bladder cancer is more frequently observed after 10 years or more of SCI.Based on these findings,a matrix was compiled where the various influencing factors,either for or against the recognition of an association between SCI and urinary bladder cancer,were weighted according to their relevance.Conclusions:The results showed that urinary bladder cancer in SCI patients differs considerably from that in ablebodied patients.The presented algorithm is an important aid in everyday clinical practice for assessing the correlation between SCI and bladder cancer.

Skin electrodes transduced signals to the bladder resulting in ameliorated hypomotility in a rabbit model of diabetes

Electric signals from a chest skin electrode can be conducted to the heart and activate contraction. In the present study, normal and diabetic rabbits were stimulated by skin electrode on the abnormal bladder projection area using three levels of exporting voltage （5.84 V, 8.00 V, and 11.00 V）. Results demonstrated significantly attenuated electric signals from both groups, in particular the diabetes group. The skin electrode signals were conducted to the bladders, and all vesical signals increased according to strength of stimulating signals from the skin electrode, However, vesical signals from diabetic rabbits were less than those from normal rabbits at the same stimulating strength of exporting voltage. Vesical pressures from the two groups increased along with increased vesical signals, but vesical pressure was less those from diabetic rabbits than in normal rabbits （basic status and different stimulating levels）. Linear correlation analysis showed a significantly positive correlation between vesical pressure and signal. These results demonstrated that electric signals from skin electrodes resulted in increased vesical pressure, and vesical pressure increased along with stimulation strength.

Disruption of sensation-dependent bladder emptying due to bladder overdistension in a complete spinal cord injury:A case report

BACKGROUNDAutonomic dysreflexia (AD) can be a life-threatening condition in patients withspinal cord injury. It is important to prevent bladder overdistension in thesepatients as it may trigger AD. Sensation-dependent bladder emptying (SDBE), asa method of bladder management, improves the quality of life and allowsphysiologic voiding. In this study, we report disruption of the SDBE habit afterbladder overdistension leading to AD with chest pain.CASE SUMMARYA 47-year-old male with a diagnosis of C4 American Spinal Cord InjuryAssociation impairment scale A had been emptying his bladder using the cleanintermittent catheterization method with an itchy sensation in the nose as asensory indication for a full bladder for 23 years, and the usual urine volume wasabout 300-400 mL. At the time of this study, the patient had delayed catheterizationfor approximately five hours. He developed severe abdominal pain andheadache and had to visit the emergency room for bladder overdistension (800mL) and a high systolic blood pressure (205 mmHg). After control of AD, ahypersensitive bladder was observed despite using anticholinergic agents. Thesensation indicating bladder fullness changed from nose itching to pain in theabdomen and precordial area. Moreover, the volume of the painful bladder fillingsensation became highly variable and was noted when the bladder urine volumeexceeded only 100 mL. The patient refused intermittent clean catheterization Finally, a cystostomy was performed, which relieved the symptoms.CONCLUSIONPatients using physiologic feedback, such as SDBE, for bladder management arerecommended to avoid bladder overdistension.

Tanshinone ⅡA improves functional recovery in spinal cord injury-induced lower urinary tract dysfunction

Tanshinone ⅡA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone ⅡA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone ⅡA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion（L6–S1） cells was less after treatment with tanshinone ⅡA. The effects of tanshinone ⅡA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone ⅡA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.