title: Lower abdominal pressure versus external bladder stimulation to aid bladder emptying in multiple sclerosis: a randomized controlled study.
abstract: OBJECTIVE
  To investigate the change in post-void residual bladder volumes (PVR) with 'abdominal vibration' using a percutaneous bladder stimulator in multiple sclerosis (MS) patients compared with either 'no treatment' or 'abdominal pressure'.
  
  
  METHODS
  Randomized controlled cross-over study.
  
  
  METHODS
  Regional neurorehabilitation clinics.
  
  
  METHODS
  Twenty-eight MS patients with urinary symptoms and PVR > 100 ml. Twelve patients had urinary incontinence.
  
  
  METHODS
  MS patients with voiding dysfunction and elevated PVR of 100-500 ml on BVI-3000 Ultrasound Scanner were randomized to either 'abdominal pressure' or 'vibration' by a portable, percutaneous, vibrating device (Queen Square Bladder Stimulator; Malem Medical) or to 'no treatment'. PVR was assessed at the end of each two-week phase.
  
  
  METHODS
  PVR reduction by greater than 100 ml.
  
  
  RESULTS
  The 28 patients ranged in age from 29 to 71 years with a mean age of 49 years and a mean duration of MS of 12 years (range 1-37 years). The PVR decreased from 231 (SD 119) ml during no treatment to 191 (SD 132) ml with abdominal pressure (p = 0.242). Using suprapubic vibration the PVR reduced further to 126 (SD 121) ml, which was highly significant (p = 0.002) compared with no treatment. The difference between abdominal pressure and vibration just failed to reach significance (p = 0.059). There was no significant reduction in either the frequency of micturition or episodes of incontinence. The device was well-tolerated by patients.
  
  
  CONCLUSIONS
  Abdominal vibration is an effective method of reducing PVR in MS patients and appears more effective than abdominal pressure alone.
authors.affiliation: Neurorehabilitation Unit, Astley Ainslie Hospital, Edinburgh, Scotland, UK.
authors.forename: R S
authors.initials: RS
authors.lastname: Prasad
authors.forename: S J
authors.initials: SJ
authors.lastname: Smith
authors.forename: H
authors.initials: H
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000534:rehabilitation*; D011312:Pressure; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology* / Q000628:therapy*; D014732:Vibration