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Purpose Evaluate if low-frequency bladder vibration (LFBV) combined with clean intermittent catheterization (CIC) alleviated urinary tract infections (UTIs) in spinal cord injury (SCI) patients with neurogenic bladder (NB). Methods A single-blind randomized controlled trial was conducted. Patients who developed UTIs while rehabilitating from SCI were enrolled continuously between January 2021 and March 2023 and randomly assigned to the control or the intervention group. Patients in the intervention group received LFBV twice daily (5–10 Hz, 5–10 min each time) for 10 days. The primary endpoint was urinary leucocytes, and various other UTI indexes were also tracked. The follow-up lasted four weeks. Results The control group (n = 44) and the intervention group (n = 43) were indistinguishable in the basic patient characteristics. Compared to the control group, the intervention group has significantly higher urinary leucocytes on day 2 and significantly lower urinary leucocytes and urinary bacteria on day 10. Four weeks after LFBV, the intervention group had significantly lower urinary leucocytes and post-void residual volume, fewer signs and symptoms of urinary tract infection, as well as significantly higher urine volume. There was no significant change in urinary red blood cells or occult blood due to LFBV. Conclusion Applying LFBV to SCI/NB patients with UTIs is recommended.

Urinary incontinence is a common complication in stroke survivors for whom new interventions are needed. This study investigated the therapeutic effect of low-frequency (LF) repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (M1) in patients with poststroke urinary incontinence (PSI). A total of 100 patients were randomly assigned to the rTMS group or sham-rTMS group on basis of the intervention they received. Both groups underwent five treatment sessions per week for 4 weeks. Data from the urodynamic examination were used as the primary outcome. The secondary outcome measures were questionnaires and pelvic floor surface electromyography. After 4 weeks of intervention, the maximum cystometric capacity (MCC), maximum detrusor pressure (Pdet.max), residual urine output, overactive bladder score (OABSS) (including frequency, urgency, and urgency urinary incontinence), and the ICIQ-UI SF improved significantly in the rTMS group compared with those in the sham-rTMS group (P < 0.05). However, no changes in pelvic floor muscle EMG were detected in patients with PSI (both P > 0.05). Our data confirmed that 4 weeks of LF-rTMS stimulation on the contralateral M1 positively affects poststroke urinary incontinence in several aspects, such as frequency, urgency urinary incontinence, MCC, end-filling Pdet, OABSS, and ICIQ-UI SF scores.

Background Neurogenic bladder (NGB) dysfunction after spinal cord injury (SCI) is generally irreversible. Preliminary animal and human studies have suggested that initiation of sacral neuromodulation (SNM) immediately following SCI can prevent neurogenic detrusor overactivity and preserve bladder capacity and compliance. We designed a multicenter randomized clinical trial to evaluate the effectiveness of early SNM after acute SCI. Methods/Design The scientific protocol comprises a multi-site, randomized, non-blinded clinical trial. Sixty acute, acquired SCI patients (30 per arm) will be randomized within 12 weeks of injury. All participants will receive standard care for NGB including anticholinergic medications and usual bladder management strategies. Those randomized to intervention will undergo surgical implantation of the Medtronic PrimeAdvanced Surescan 97,702 Neurostimulator with bilateral tined leads along the S3 nerve root in a single-stage procedure. All patients will undergo fluoroscopic urodynamic testing at study enrollment, 3 months, and 1-year post randomization. The primary outcome will be changes in urodynamic maximum cystometric capacity at 1-year. After accounting for a 15% loss to follow-up, we expect 25 evaluable patients per arm (50 total), which will allow detection of a 38% treatment effect. This corresponds to an 84 mL difference in bladder capacity (80% power at a 5% significance level). Additional parameters will be assessed every 3 months with validated SCI-Quality of Life questionnaires and 3-day voiding diaries with pad-weight testing. Quantified secondary outcomes include: patient reported QoL, number of daily catheterizations, incontinence episodes, average catheterization volume, detrusor compliance, presence of urodynamic detrusor overactivity and important clinical outcomes including: hospitalizations, number of symptomatic urinary tract infections, need for further interventions, and bowel and erectile function. Discussion This research protocol is multi-centered, drawing participants from large referral centers for SCI and has the potential to increase options for bladder management after SCI and add to our knowledge about neuroplasticity in the acute SCI patient. Trial registration ClinicalTrials.gov # NCT03083366 1/27/2017.

Background Neurogenic detrusor overactivity (NDO) is a serious and common complication after spinal cord injury, affecting patients’ quality of life seriously. Therefore, we developed this research protocol to evaluate the efficacy of repetitive functional magnetic stimulation (rFMS) in the sacral nerve in patients with neurogenic detrusor overactivity (NDO) after suprasacral spinal cord injury (SCI) and provide more options for rFMS in treating NDO after suprasacral SCI. Methods This study is a single-center, randomized, parallel-group clinical trial. We will recruit the patients with NDO after suprasacral SCI in the Rehabilitation Department of the Affiliated Hospital of Southwest Medical University from September 2022 to August 2023. They will be assigned to the rFMS group and the sham stimulation group randomly. The sample size is 66, with 33 patients in each group. The rFMS group will receive real rFMS treatment of the sacral nerve (100% stimulation intensity, 5 Hz, 20 min each time, five times a week), and the sham group will receive sham stimulation. Both groups will receive similar treatment strategies, including medication, standard urine management, acupuncture treatment, and health education. The bladder compliance (bladder capacity/detrusor pressure) and pudendal nerve electromyography will be evaluated at baseline, 8th week of treatment. The residual volume of the bladder and bladder diary will be recorded once a week during 8 weeks of treatments. SCI-QOL and NBSS will be evaluated at baseline, the 4th and 8th week of treatment. In addition, the above assessments will be followed up at 8 weeks after the end of treatment. Discussion It is expected that the bladder function, symptoms, and quality of life might be significantly improved after rFMS of the sacral nerve. Trial registration The China Clinical Trials Registry has approved this study, registration number: ChiCTR2100045148. Registered on April 7, 2021.

ObjectiveNeurogenic bladder (NGB) is a serious complication after spinal cord injury (SCI), a destructive neurological disease. This study focused on exploring the efficacy of the magnetic stimulation of sacral nerve roots combined with Tui-na in treating NGB after SCI.MethodsOne hundred patients with NGB after SCI were studied, and intermittent clean catheterization was performed with a water intake program, and patients were grouped into four groups by the random number table method: general treatment group, Tui-na group, magnetic stimulation group, and combined treatment group. A series of relevant factors (voiding diary, urodynamics, and quality of life scores) and clinical efficacy of patients in the four groups before and after treatment were observed.ResultsThe magnetic stimulation of sacral nerve roots alone, Tui-na alone, and the combination of both were all effective in improving bladder function and quality of life in patients with NGB after SCI, including improvements in voiding frequency, single urine output, maximum urine output, residual urine output, bladder volume and quality of life scores in patients with NGB after SCI. The efficacy of the magnetic stimulation of sacral nerve roots combined with Tui-na was better than that of the magnetic stimulation of sacral nerve roots alone and the Tui-na alone.ConclusionThis research demonstrates that the magnetic stimulation of sacral nerve roots combined with Tui-na treatment could effectively improve the urinary system and the quality of life of patients with NGB after SCI, which is worthy of clinical promotion and application.

Neurogenic bladder (NB) dysfunction in individuals with complete spinal cord injury (SCI) is a condition that significantly affects quality of life. Despite the prevalence of interventions, there is a substantial gap in effective treatments for this dysfunction. This study proposes robotic-assisted gait training combined with motor imagery (MI)-based brain-computer interface (BCI) to induce improved cortical modulation, and consequently improve bladder function in patients with SCI. The study involved seven men with complete and chronic SCI in a protocol comprising 24 sessions of robotic-assisted walking with BCI and MI. This regimen was designed to teach both mu ( µ , 8–12 Hz) and beta ( β , 15–20 Hz) modulation through MI practices using multi-channel EEG neurofeedback (NFB), focusing on sensorimotor rhythm (SMR) activation. Clinical outcomes were measured using the neurogenic bladder symptom score (NBSS), which revealed substantial improvements in bladder control among participants. EEG analysis confirmed a significant correlation between modulation of µ and β rhythms with decreased NBSS scores. Our findings support that robotic-assisted gait training combined with MI-based BCI effectively modulates with more precision the cortical µ and β rhythms and improves NB dysfunction in SCI individuals.

Background Neurogenic bladder due to myelomeningocele (MMC) is a significant risk factor for chronic kidney disease in children. Cystatin C (CysC) is a more accurate GFR marker than creatinine as it is unaffected by muscle mass but may be influenced by fat mass and BMI. This study evaluates: (1) GFR measurement accuracy using CysC and creatinine in MMC-related neurogenic bladder, (2) the relationship between body composition via bioelectrical impedance analysis (BIA) and renal parameters, and (3) the use of BIA for non-invasive GFR and body composition assessment. Methods Forty children (median age 9.96 years) underwent serum creatinine, CysC testing, and BIA measurements. We assessed age, sex, spinal lesion level, anthropometric measurements, BMI, and activity using Hoffer’s scale. GFR was calculated using five creatinine-based formulas, three CysC-based, and three combining CysC and creatinine, including BIA GFR as an alternative approach. Results Creatinine-based GFR estimates were significantly higher than CysC-based GFR. Although only 30% of MMC patients met the traditional BMI criteria for overweight/obesity, 62.5% were obese based on BIA-measured body fat percentage. Significant differences were found in CysC and CysC-based GFR equations within BMI and fat mass groups. Positive correlations were observed between CysC and body weight, BMI percentiles, body fat mass and fat-to-muscle ratio. Muscle mass positively correlated with creatinine. Conclusions BIA-determined fat mass percentage is a more sensitive obesity indicator than BMI in MMC patients. CysC levels and CysC-based GFR equations are influenced by body fat mass, requiring consideration of adiposity to avoid misestimating renal impairment. Graphical abstract A higher resolution version of the graphical abstract is available as supplementary information

This study aims to investigate the therapeutic efficacy and complications of low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept in central neurogenic bladder (CNB). This study was a prospective, randomized controlled trial. Sixty patients diagnosed with CNB without prior treatment were randomly divided into two groups: the control group (n = 30) was treated with basic rehabilitation training, and the treatment group (n = 30) was treated with basic rehabilitation training plus low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept for 4 weeks. The fixed acupuncture points selected were: Sanyinjiao (bilateral), Zhongji (unilateral), and Diji (unilateral). The study compared pre- and post-treatment clinical curative effects, urodynamic indicators, urination status, the Neurogenic Bladder Symptom Score (NBSS), the Urinary Symptom Distress Scale (USDS), the World Health Organization Quality of Life Brief Inventory (WHOQOL-BREF), and the occurrence of adverse reactions and complications between the two groups. The overall efficacy rate of 96.67% in the treatment group was significantly higher than that in the control group (86.67%) (P < 0.05). After treatment, the MBC, MFR, Pdet, DASUV, and WHOQOL-BREF scores significantly increased, while the RUV, DUF, DAUL, NBSS and USDS scores all decreased in both groups, with the treatment group showing significantly better results than the control group (P < 0.05). There was no statistically significant difference in adverse reactions and complication rates between the two groups (P > 0.05). Low-frequency acupuncture therapy based on the Midnight-Noon Ebb-Flow concept significantly improves bladder function and alleviates urinary difficulties in CNB, demonstrating good safety and considerable clinical applicability.

Neurogenic bladder (NGB) is an encompassing term that includes multiple causes of bladder dysfunction linked to a congenital or acquired neurological condition that adversely impacts the innervation of the lower urinary tract. Multiple static or progressive conditions can be associated with NGB in pediatric and adolescent patients. Currently, spinal dysraphism (i.e., spina bifida) is one of the most common etiologies, which occurs in 3–4 per 10,000 live births in developed nations. Abnormal bladder dynamics can lead to kidney damage secondary to high pressures or recurrent infections, as well as urinary incontinence. The current management paradigm centers on a proactive approach to preserving kidney function and achieving continence through behavioral, pharmacological, and surgical means. This educational review highlights the key components of urological management to maximize collaboration with pediatric nephrologists.

Background Augmentation cystoplasty (AC) is a procedure to improve the clinical and urodynamic parameters of neurogenic bladder (NB) in children and adolescents refractory to other treatments. We performed a systematic review to investigate these parameters in children and adolescents with NB undergoing AC. Methods We followed PRISMA guidelines and searched electronic databases until March 2024 for studies involving patients aged three to 19 years diagnosed with NB undergoing AC. We assessed clinical and urodynamic parameters before and after surgery, focusing on improvements in urinary incontinence, vesicoureteral reflux (VUR), bladder capacity, compliance, and end filling detrusor pressure (EFP). Results A total of 212 NB patients underwent AC and were evaluated for urinary incontinence before and after surgery. Two studies showed a 76.5% to 78.9% improvement in incontinence without bladder outlet procedures (BOP). Another study found no significant difference in incontinence improvement rates between AC with and without BOP. The VUR resolution rate assessed in three studies ranged from 12.5 to 64%. Three studies showed a variation in bladder capacity from 52.8 to 70% of the expected bladder capacity pre-AC to 95.9 to 119%, post-AC. A fourth study showed a variation in bladder capacity from 87 ml pre-AC to 370 ml post-AC. Two studies showed a variation from 3.2 to 4.6 ml/cm H 2 O pre-AC to 13.7 to 41.3 ml/cm H 2 O post-AC in bladder compliance. The EFP in three studies varied from 37.2 to 47.6 cm H 2 O pre-AC to 11 to 17.4 cm H 2 O post-AC. Conclusion After AC, urinary incontinence, bladder capacity, EFP, and bladder compliance improved in children and adolescents with NB. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information