Pd07-07 Bilateral Pudendal Nerve Block Reduces Urethral Pressure in Sci Patients With Desd

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (PD07)1 May 2024PD07-07 BILATERAL PUDENDAL NERVE BLOCK REDUCES URETHRAL PRESSURE IN SCI PATIENTS WITH DESD Christopher Chermansky, Vickie Polanco-Garcia, Andrew Moyer, William de Groat, and Changfeng Tai Christopher ChermanskyChristopher Chermansky , Vickie Polanco-GarciaVickie Polanco-Garcia , Andrew MoyerAndrew Moyer , William de GroatWilliam de Groat , and Changfeng TaiChangfeng Tai View All Author Informationhttps://doi.org/10.1097/01.JU.0001008552.16893.70.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We have previously shown in ASIA-A T9 SCI cats that DESD could be blocked with high frequency, biphasic, bilateral pudendal stimulation. Now we report on our initial SCI patients with DESD treated with our FDA-approved Nerve Block and Stimulation External Pulse Generator. METHODS: The study was approved by the WCG and University of Pittsburgh IRBs. Patients were recruited with ASIA-A SCI between T7 and L5 of at least 1-year duration. On urodynamics (UDS), they demonstrated DESD with or without NDO. A triple lumen urethral urodynamic catheter was placed to record detrusor and urethral pressures. Needle electrodes were placed in the anal sphincter to measure compound muscle action potentials (C-MAP). UDS commenced until capacity was reached. Crede maneuver was performed, and urethral and bladder pressures were recorded. Fluoroscopy was used to insert bilateral foramen needles medial to the ischial tuberosity toward the ischial spine. During insertion, each needle was stimulated at 5 Hz and 0.2 ms until optimal pudendal nerve stimulation was confirmed with C-MAP and anal twitch. Bilateral block began with stimulation at 1 kHz and 1mA for 30 seconds. If urethral pressure during Crede was not reduced to <50 cm H2O, the stimulation was repeated at 1 kHz and 3.8mA for 30 seconds, for 1 minute, for 2 minutes, and for 4 minutes. The primary endpoint was reduction in urethral pressure <50 cmH2O. Any adverse events (AEs) were recorded. RESULTS: A total of 3 patients completed the study. The first subject is a 56-year-old male with T9 ASIA-A SCI, and UDS showed DESD but no NDO. The urethral pressure in this first subject was reduced from 65 cm H2O to 35 cm H2O with a stimulation of 1 kHz and 3.8mA for 4 minutes. The second subject is a 46-year-old female with T9 ASIA-A SCI, and UDS showed both DESD and NDO. Because urethral pressure was difficult to measure from NDO, bladder leak point pressure was used and this was reduced from 70 cm H2O to 51 cm H2O with a stimulation of 1 kHz and 3.8mA for 4 minutes. The third subject is a 55-year-old male with T10 ASIA-A SCI, and UDS showed both DESD and NDO. The urethral pressure in this subject was reduced from 62 cm H2O to 23 cm H2O with a stimulation of 1 kHz and 3.8mA for 30 seconds. The only AE noted was mild nausea in one subject. CONCLUSIONS: Successful reductions in urethral or bladder leak point pressures were seen in 3 SCI patients with DESD using bilateral pudendal nerve stimulation at 1 kHz. The only adverse event was mild nausea. This study supports the development of an implantable device to treat DESD by bilateral pudendal nerve block using 1 kHz stimulation. Source of Funding: This study is funded by the Bridging the Gap Plus (BG+) program of the Defense Advanced Research Projects Agency (DARPA) under the contract N66001-20-C-4050 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e169 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Christopher Chermansky More articles by this author Vickie Polanco-Garcia More articles by this author Andrew Moyer More articles by this author William de Groat More articles by this author Changfeng Tai More articles by this author Expand All Advertisement PDF downloadLoading ...