Intravesical Transurethral Electrotherapy for the Neurogenic Bladder

Abstract

Intravesical transurethral bladder stimulation is a rehabilitative and diagnostic technique for the neurogenic bladder. The goal of therapy is 3-fold: 1) to achieve the sensation of bladder filling or the urge to void, 2) to initiate a detrusor contraction and 3) to achieve conscious urinary control. The procedure combines direct electrical stimulation of bladder receptors with visual biofeedback using patient observance of a water manometric representation of the detrusor response. Since November 1984 we have evaluated and/or treated 24 patients with a neurogenic bladder. An electrocatheter is passed transurethrally into the bladder and the bladder is filled to a third of its capacity with normal saline. We then deliver 2 to 6 mA. every 3 seconds for 90 minutes. Full treatment usually requires 30 to 90 sessions. Of the 24 patients 13 had only 1 evaluation and 10 had 3 to 39 sessions. Of those 10 patients 7 had significant detrusor activity that had not been present before treatment and 4 have a sensation to void. The remaining child underwent 110 sessions. He has controlled detrusor contractions resulting in a normal voiding pattern. It appears that intravesical transurethral bladder stimulation may be helpful diagnostically to determine the stimulus response of bladder function and therapeutically to rehabilitate the neurogenic bladder toward full control.