title: Multisystem neuroprosthetic training improves bladder function after severe spinal cord injury.
abstract: Severe spinal cord injury leads to neurogenic bladder dysfunction. We recently developed a multisystem neuroprosthetic training program that promotes plastic changes capable of restoring refined locomotion in rats with severe spinal cord injury. We investigated whether multisystem neuroprosthetic training would influence the development of posttraumatic bladder dysfunction.
  
  
  METHODS
  Eight and 4 adult rats were randomly assigned to a spinal cord injury and an intact control group, respectively. Spinal cord injury consisted of 2 opposite lateral hemisections (T7 and T11), thus, interrupting all direct supraspinal input. After spinal cord injury 4 rats were subjected to a multisystem neuroprosthetic training program and 4 were not trained. At 8 weeks we performed urodynamics and evaluated kidney function using creatinine and cystatin C. Bladder investigation included morphological, histological and immunohistochemical evaluations.
  
  
  RESULTS
  Bladder capacity increased threefold in trained and sevenfold in nontrained rats compared to intact rats. During filling we found a mean ± SEM of 2.7 ± 1.1 vs 12.6 ± 5.2 nonvoiding contractions in trained vs nontrained rats. Bladder morphology was similar in trained and intact rats. Nontrained rats showed detrusor hypertrophy, characterized by increased detrusor thickness and a decreased connective tissue-to-smooth muscle ratio. As labeled with protein gene product 9.5, general nerve density was significantly increased in trained and significantly decreased in nontrained rats. The relative proportion of neurofilament 200 positive afferent nerves was significantly lower in trained than in intact and nontrained rats. Neuropeptide Y positive fibers showed significantly lower density in nontrained rats.
  
  
  CONCLUSIONS
  Multisystem neuroprosthetic training effectively counteracts the formation of neurogenic bladder dysfunction after severe spinal cord injury and might contribute to preserving bladder function and preventing long-term complications in patients with severe spinal cord injury.
authors.affiliation: Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University of Zurich, Zurich, Switzerland.
authors.forename: Maya
authors.initials: M
authors.lastname: Horst
authors.forename: Janine
authors.initials: J
authors.lastname: Heutschi
authors.forename: Rubia
authors.initials: R
authors.lastname: van den Brand
authors.forename: Karl-Erik
authors.initials: KE
authors.lastname: Andersson
authors.forename: Rita
authors.initials: R
authors.lastname: Gobet
authors.forename: Tullio
authors.initials: T
authors.lastname: Sulser
authors.forename: Grégoire
authors.initials: G
authors.lastname: Courtine
authors.forename: Daniel
authors.initials: D
authors.lastname: Eberli
mesh_terms: D000818:Animals; D004599:Electric Stimulation Therapy / Q000379:methods; D055664:Electrochemical Techniques; D005260:Female; D015601:Injury Severity Score; D051381:Rats; D011917:Rats, Inbred Lew; D012371:Robotics; D013119:Spinal Cord Injuries / Q000150:complications*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000628:therapy*