Pudendal neuromodulation improves voiding efficiency in diabetic rats.
OBJECTIVE
Diabetic cystopathy is typically manifested as bladder voiding dysfunction, and numerous patients are refractory to standard therapy. In this study, we determined whether electrical stimulation (ES) of the sensory branch of the pudendal nerve could engage an augmenting reflex and thereby improve bladder emptying in a diabetic animal model with cystopathy.


METHODS
The efficiency of bladder emptying with ES of the sensory branch of the pudendal nerve at different stimulation intensities was measured in rats at 8 or 18 weeks after the induction of diabetes with streptozotocin.


RESULTS
The voiding efficiency (VE) was reduced from 74 ± 4% to 30 ± 8% in rats with diabetes for 8 weeks and from 73 ± 6% to 20 ± 6% in rats with diabetes for 18 weeks. ES at lower intensities (0.025-0.05 mA) applied to the pudendal sensory nerve did not affect the VE in rats with diabetes for 18 weeks but increased the VE in rats with diabetes for 8 weeks. Subsequently, when the stimulation intensity was elevated to 0.1-0.3 mA, the VEs in rats with diabetes for both 8 and 18 weeks increased to 40-50%.


CONCLUSIONS
The results of the present study are consistent with the essential role for pudendal sensory feedback in efficient bladder emptying, and electrical activation of the sensory branch of the pudendal nerve was efficient restoring the voiding function in diabetic animals with cystopathy. This could provide an approach to improve bladder emptying in diabetic patients with voiding dysfunction.
Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Shih-Ching
SC
Chen
Chien-Hung
CH
Lai
Wen-Jia
WJ
Fan
Chih-Wei
CW
Peng
D000818:Animals; D003921:Diabetes Mellitus, Experimental / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D003929:Diabetic Neuropathies / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004195:Disease Models, Animal; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography; D056228:Feedback, Sensory; D008297:Male; D060525:Pudendal Nerve / Q000503:physiopathology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012018:Reflex; D013997:Time Factors; D014521:Urethra / Q000294:innervation* / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology*; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D014554:Urination; D014563:Urodynamics