OBJECTIVE To study the short-term effect of bilateral transcutaneous tibial nerve stimulation (TTNS) on urodynamic study (UDM) parameters in spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO). DESIGN Single-blinded sham-controlled study. SETTING Rehabilitation center. PARTICIPANTS Seventeen SCI patients with NDO were recruited. Fifteen patients (mean age 40±18 years) completed the study. Most of them were chronic incomplete SCI. INTERVENTIONS UDM was performed three times. The first UDM was performed after taking anticholinergics for one hour to assess the effects of medication. After stopping anticholinergics for a 5 half-lives, the second UDM was performed immediately after a 20-min sham TTNS (switch on for 30 sec at the beginning, switch off for 20 min, and switch on for 30 sec before stopping). The third UDM was performed immediately after a 20-min bilateral TTNS. MAIN OUTCOME MEASURES Reflex volume (ml); cystometric capacity (ml); maximum pressure detrusor (mmH2O); and bladder compliance (ml/mmH2O). RESULTS UDM tracings were interpreted by 2 blinded assessors. This study used per-protocol analysis and repeated measures ANOVA with Bonferroni post-hoc analysis. When compared with sham stimulation, bilateral TTNS and anticholinergics produced greater increases in reflex volume (136.1±99.88, 212.2±112.82, 226.3±111.52 ml, P<.001), cystometric capacity (218.3±137.66, 319.1±143.74, 350.7±163.43 ml, P<.001) and compliance (5.8±6.81, 7.9±6.74, 9.7±8.12 ml/cmH2O, P=.02). No significant differences in reflex volume, cystometric capacity or compliance were found between bilateral TTNS and anticholinergics (P>.05). The maximum pressure detrusor was not significantly different between groups (P>.05). CONCLUSION Bilateral TTNS may be an effective short-term intervention to improve UDM parameters in SCI with NDO. Further study is necessary to determine the long-term effects and benefits of combined bilateral TTNS with anticholinergics.

中文翻译：

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双侧经皮胫神经刺激对脊髓损伤神经源性逼尿肌过度活动的影响：一项尿动力学研究

目的 研究双侧经皮胫神经刺激 (TTNS) 对神经源性逼尿肌过度活动 (NDO) 脊髓损伤 (SCI) 患者尿动力学研究 (UDM) 参数的短期影响。设计 单盲假对照研究。设置康复中心。参与者招募了 17 名患有 NDO 的 SCI 患者。15 名患者（平均年龄 40±18 岁）完成了这项研究。他们中的大多数是慢性不完全SCI。干预 UDM 进行了 3 次。第一次 UDM 是在服用抗胆碱能药物一小时后进行的，以评估药物的效果。在停止抗胆碱能药物 5 个半衰期后，在 20 分钟假 TTNS 后立即进行第二次 UDM（开始时开启 30 秒，关闭 20 分钟，并在停止前开启 30 秒）。第三次 UDM 在 20 分钟双边 TTNS 后立即进行。主要观察指标 反射容积 (ml)；膀胱容量 (ml); 最大压力逼尿肌（mmH2O）；和膀胱顺应性 (ml/mmH2O)。结果 UDM 追踪由 2 位不知情的评估员解释。本研究使用符合方案分析并通过 Bonferroni 事后分析重复测量方差分析。与假刺激相比，双侧 TTNS 和抗胆碱能药物产生更大的反射体积增加 (136.1±99.88, 212.2±112.82, 226.3±111.52 ml, P<.001), 膀胱容量 (218.3±137.66, 3434.43.7±1.37.37.82 ml, P<.001) 和顺应性 (5.8±6.81, 7.9±6.74, 9.7±8.12 ml/cmH2O, P=.02)。双侧 TTNS 和抗胆碱能药物在反射量、膀胱容量或顺应性方面没有发现显着差异（P>.05）。最大压力逼尿肌在各组之间没有显着差异（P>.05）。结论 双侧 TTNS 可能是一种有效的短期干预措施，可改善 NDO SCI 中的 UDM 参数。需要进一步研究以确定双侧 TTNS 与抗胆碱能药联合的长期效果和益处。