Schurch
Fakultäten » Medizinische Fakultät » Universitätsklinik Balgrist und Schweizerisches Paraplegikerzentrum » Paraplegikerzentrum » Prof. Dr. Volker Dietz (emeritiert) » Schurch
Completed research project
| Title / Titel | Urodynamical and electrophysiological assessment of normal and impaired human bladder function | ||
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| Abstract (PDF, 14 KB) | |||
| Summary / Zusammenfassung | This proposal concentrates upon three aspects of the human bladder function: the physiological basis of the somatic and autonomic innervation of the bladder, the pathophysiology of neurogenic voiding disorders associated with an impairment of the autonomic nervous system and the assessment of new therapeutic approaches of the neurogenic voiding disorders. The main goals of the research project will be achieved by using combined electrophysiological and urodynamical recordings in healthy subjects and in patients with acute and chronic spinal cord injury/disease. The experiments will consist in: 1) the assessment of the effect of the urethro-vesical afferent stimulation on the control of the bladder function 2) the assessment of the influence of bladder activity upon cardiovascular system 3) the evaluation of new therapeutic methods for voiding disorders in neurogenic and non-neurogenic patients, including pharmaceutical experiments and electrostimulation. Consequences from our previous research for this proposal: 1) Magnetic stimulation combined with urodynamic examination is a valuable diagnostic tool for the investigation of the somatic efferent pathways of the lower urinary tract in patients suffering from micturition disorders. However, no successful direct stimulation of the autonomic efferent nerve pathways using magnetic stimulation was achieved either in healthy subjects or in SCI patients. This might be explained by the limitation of the stimulation paradigm especially the limited duration of the stimulation train. We aim now at performing magnetic stimulation of the motor nerve pathways by using a new magnetic stimulator, which enables long-train magnetic stimulation, By such a proposal we might be able to stimulate the autonomic efferent nerve pathways and to differentiate central from peripheral nerve lesions. This will be of relevance in the examination of the autonomic part of the nervous system innervating the lower urinary tract, in patients suffering from voiding disorders with or without lesion within the CNS. Moreover, the application of continuous magnetic stimulation might contribute to the rehabilitation process of micturition disorders. 2) In our previous research, simultaneous urodynamic and viscero-sensible evoked potential recordings was proved to be reliable method to assess impaired viscerosensibility of the lower urinary tract. However, this method is time consuming, remains technically difficult and cannot be used routinely in daily practice. Therefore, the value of the sympathetic skin response (SSR) recordings during urodynamic examination in the assessment of the sensory nervous pathways of lower urinary tract was evaluated using different stimulation trials. Recordings of SSR after electrical stimulation appears to be a very valuable tool to assess part of the afferent arising from the lower urinary tract. The recordings of the sympathetic skin response will further be used to assess spinal and supraspinal reflexes. This might identify some somato-autonomic interaction and explain autonomic processes in the isolated spinal cord. 3) The therapeutic part of our project concerned the improvement of the bladder (voiding) function of patients suffering from SCI or other disorders of the spinal cord (e.g. multiple sclerosis, tumour). Two new therapeutic approaches have been used. In the first this experiment, we were able for the first time world-wide to resolve major detrusor hyperreflexia and severe neurogenic incontinence resistant to other pharmacological treatment, by making use of injections of botulinum A toxin into the detrusor. Further investigations are necessary to assess long-term safety. For this issue, we aim to perform immunohistochemical and ultrastructural examination of the detrusor muscle. In a second approach, we have investigated the role of sacral nerve stimulation in treating neurogenic incontinence. From our findings it appeared that sacral nerve stimulation might be useful in incomplete SCI patients. The next step is a better understanding of the nervous pathways involved in this process, as well as of the supraspinal changing that occurs after a neurological lesion to improve such therapeutic approaches. |
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| Publications / Publikationen | Reitz A, Schmid DM, Curt A, Knapp PA, Schurch B. Sympathetic sudomotor skin activity in human after complete spinal cord injury. Auton Neurosci. 2002 Nov 29;102(1-2):78-84.Reitz A, Schmid DM, Curt A, Knapp PA, Jensen K, Schurch B. Electrophysiological assessment of sensations arising from the bladder: are there objective criteria for subjective perceptions? J Urol. 2003 Jan;169(1):190-4.Rodic B, Schlapfer A, Curt A, Knapp P, Dietz V, Schurch B. Magnetic stimulation of sacral roots for assessing the efferent neuronal pathways of lower urinary tract. Muscle Nerve. 2002 Oct;26(4):486-91. | ||
| Keywords / Suchbegriffe | Spinal cord injury, Neurogenic bladder disorders, Autonomic nervous system, Somatic nervous system, Urodynamic examinations, Electrophysiological examinations, Neuromodulation, Magnetic stimulation, Botulinum toxin-A | ||
| Project leadership and contacts / Projektleitung und Kontakte |
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| Funding source(s) / Unterstützt durch |
SNF (Personen- und Projektförderung) |
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| Duration of Project / Projektdauer | Dec 2002 to Nov 2006 |