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Modulation of the micturition reflex pathway by intravesical electrical stimulation: An experimental study in the rat
Linköping University, Department of Clinical and Experimental Medicine, Cellbiology. Linköping University, Faculty of Health Sciences.
1998 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, Vol. 17, no 5, 543-554 p.Article in journal (Refereed) Published
Abstract [en]

Intravesical electrical stimulation (IVES) is used clinically to improve bladder evacuation in patients with inadequate micturition contractions. The procedure involves field stimulation of A bladder mechanoreceptor afferents resulting in a prolonged enhancement of the micturition reflex. The aim of the present experimental study in the rat was to identify the site for this neuromodulation, whether it was due to sensitization of bladder mechanoreceptors, to enhancement of transmission in the central micturition reflex pathway, or to improved effectiveness of the peripheral motor system of the bladder. The experiments were performed on female rats, anesthetized by -chloralose. Multi-unit afferent or efferent activity was recorded from bladder pelvic nerve branches during repeated cystometries before and after IVES. The specific antagonist CPPene was used to block central glutaminergic receptors of NMDA type. Micturition threshold volume decreased significantly after IVES. The afferent threshold volume, peak response, and pressure sensitivity were unchanged as were the peak efferent activity and bladder contractility. There was no efferent activity until just before the micturition contraction. The IVES-induced decrease in micturition threshold was blocked by prior administration of the NMDA (N-methyl-D-aspartic acid) antagonist CPPene (3-(2-carboxypiperazin-4-yl)-1-propenyl-1-phosphonic acid). The findings indicate that the IVES-induced modulation of the micturition reflex is due to an enhanced excitatory synaptic transmission in the central micturition reflex pathway. The observed modulation may account for the clinical beneficial effect of IVES treatment.

Place, publisher, year, edition, pages
1998. Vol. 17, no 5, 543-554 p.
Keyword [en]
urinary bladder, electric stimulation, neuromodulation, bladder afferent, bladder efferent, micturition reflex, NMDA antagonist, rat
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13506DOI: 10.1002/(SICI)1520-6777(1998)17:5<543::AID-NAU11>3.0.CO;2-GOAI: diva2:20877
Available from: 1999-02-25 Created: 1999-02-25 Last updated: 2009-02-16Bibliographically approved
In thesis
1. Prolonged Modulation of the Micturition Reflex by Electrical Stimulation
Open this publication in new window or tab >>Prolonged Modulation of the Micturition Reflex by Electrical Stimulation
1999 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Intravesical electrical stimulation (IVES) has been used in treatment of patients with urinary bladder dysfunctions for more than four decades. While some investigators have reported excellent results others have observed less convincing effects or outright failures. The discrepancies may reflect differences in patient selection or stimulation procedure. A better theoretical understanding of the IVES working mechanism might help to improve the success rate of the treatment. The aims of the present study were to provide such information.

Experiments were performed on adult female cats and rats under /alpha/-chloralose anesthesia. IVES was delivered by a catheter electrode in the bladder. At proper intensity and frequency, IVES evoked reflex detrusor contractions that were abolished by bilateral rhizotomy of sacral dorsal roots. Stimulation parameters and response characteristics revealed that bladder mechanoreceptor A/delta/ afferents were activated by the IVES, the same afferents that drive the normal micturition reflex.

Five minutes of continues IVES at 20 Hz induced a prolonged, significant decrease in the micturition threshold volume of anesthetized rats. Similarly, selective bladder A/delta/ afferent stimulation induced a long-lasting enhancement of micturition reflex discharges in cats. A comparable prolonged inhibitory effect on the micturition reflex was demonstrated after ano-genital afferent stimulation. Both modulatory effects occurred without changes in response sensitivity of stimulated afferents. The IVES induced modulation was prevented by transient exposure of the bladder to a local anesthetic and by systemic administration of a glutamate NMDA receptor antagonist.

In conclusion, IVES induces a prolonged modulation of the micturition reflex by an LTP like enhancement of excitatory synaptic transmission in the central micturition reflex pathway. The findings provide an experimental explanation for the neuronal mechanisms underlying the curative effect of IVES in patients with bladder evacuation problems.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 1999. 50 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 582
Intravesical electrical stimulation, IVES, bladder evacuation problems, bladder, micturition reflex
National Category
Urology and Nephrology
urn:nbn:se:liu:diva-4989 (URN)91-7219-326-3 (ISBN)
Public defence
1999-02-12, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (English)
On the day of the public defence the status of article V was: Accepted.Available from: 1999-02-25 Created: 1999-02-25 Last updated: 2012-01-24Bibliographically approved

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