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首页> 外文期刊>BJU international >Control of the unstable urinary bladder by graded thermoelectric cooling of the spinal cord.
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Control of the unstable urinary bladder by graded thermoelectric cooling of the spinal cord.

机译：通过逐步分级的脊髓热电冷却来控制不稳定的膀胱。

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OBJECTIVE: To evaluate local lumbosacral spinal-cord cooling (a novel technique for neuromodulating urinary bladder reflexes) for its feasibility in possible clinical use, by determining the efficacy and the optimum temperature for suppressing reflex urinary incontinence in two rat models of neurogenic urinary bladder instability. MATERIALS AND METHODS: Overactivity of the detrusor muscle was induced by inflammation of the urinary bladder in a group of rats. A second group of rats was examined 6 weeks after complete midthoracic spinal cord transection, when all animals had developed neurogenic bladder hyper-reflexia. The intravesical pressure, urethral pressure and electromyographic (EMG) activity of the external urethral sphincter (EUS) were recorded simultaneously during repetitive local cooling and re-warming of the dorsal L6/S1 spinal cord segments, using a thermoelectric cooling device. RESULTS: Spinal cord cooling at L6/S1 had no influence on the recorded values at >26 degrees C, but markedly suppressed detrusor contraction frequency at 21- 25 degrees C. Cooling to <20 degrees C completely and reversibly eliminated inflammation-induced bladder contractions in rats with an intact neural axis and significantly reduced the contraction amplitudes (mean reduction 61%) and duration of contractions in spinally transected rats. Cooling simultaneously increased tonic EUS EMG activity and urethral perfusion pressure in both experimental groups, indicating closure of the urethral outlet. Cooling of adjacent spinal cord segments had no influence on bladder and urethral functions. CONCLUSION: Cooling the dorsal spinal cord at the origin of the parasympathetic innervation of the bladder can be used to reversibly suppress bladder instability with simultaneous closure of the urethral outlet. Therefore, local spinal cord cooling, e.g. as an implantable thermoelectric device, may offer a suitable method to treat detrusor overactivity and restore continence.
机译：目的：通过在两种神经源性膀胱不稳定性大鼠模型中确定抑制反射性尿失禁的功效和最佳温度，评估局部腰s脊髓冷却（一种神经调节膀胱反射的新技术）在临床上的可行性。 。材料与方法：一组大鼠的膀胱发炎引起逼尿肌过度活动。当所有动物均出现神经源性膀胱过度反射时，在完全胸中脊髓横断6周后检查第二组大鼠。使用热电冷却装置，在局部局部冷却和背侧L6 / S1脊髓节段的重复局部冷却期间，同时记录了外部尿道括约肌（EUS）的膀胱内压力，尿道压力和肌电图（EMG）活动。结果：L6 / S1的脊髓冷却对> 26°C时的记录值没有影响，但是在21-25°C时显着抑制了逼尿肌的收缩频率。完全冷却至<20°C时，可逆地消除了炎症引起的膀胱收缩具有完整神经轴的大鼠中的收缩，并且显着降低了脊髓横切大鼠的收缩幅度（平均降低61％）和收缩持续时间。冷却同时增加了两个实验组的强直性EUS EMG活性和尿道灌注压力，表明尿道出口关闭。相邻脊髓节段的冷却对膀胱和尿道功能没有影响。结论：在副交感神经支配性膀胱起源处冷却背脊髓可用于可逆性抑制膀胱不稳定性并同时关闭尿道出口。因此，局部脊髓冷却例如作为植入式热电装置，可以提供治疗逼尿肌过度活动和恢复尿量的合适方法。

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