Significance of sacral nerve electro-acupuncture stimulation on the urinary function reconstruction of neurogenic bladder in the patients with cauda equina injury

QIN Jiang; ZHAO Ya-jie; REN Neng; TANG Jia-guang; REN Dong-feng; SHI Xiu-xiu; CAO Zheng; YU Ning; TANG Jin-shu

doi:10.3969/j.issn.2095-252X.2014.09.007

Abstract：Objective To explore the effects of sacral nerve electro-acupuncture stimulation on the urinary function reconstruction in the patients with neurogenic bladder ( NB ) after cauda equina injury.Methods From September 2012 to July 2013, 20 patients with NB caused by cauda equina injury were adopted. There were 16 males and 4 females, whose average age was ( 37.37±15.83 ) years old. The complications such as upper urinary hydrops, urinary tract infections and calculi were excluded by laboratory and biochemical examinations, and then sacral nerve electro-acupuncture stimulation was performed, with 20 times as a treatment course. Intermittent catheterization combined with behavior therapy, triggering roilet and Kegel exercise ( pelvic lfoor muscle training ) was carried out, and a voiding diary was recorded. At the end of the treatment, the patients were evaluated in respects of the time of establishing a balanced bladder, ratio of voiding and residual urine volume, Quality of Life ( QOL ), biochemical examination and imaging examination. All the patients were followed up for half a year, and the relevant data were collected and analyzed so as to draw a conclusion.Results No severe side effects were noticed in all the patients. <br> There were 8 patients with urinary leakage, among whom 2 patients chose surgical treatment due to repeated low-grade fever, generalized weakness and refusal to accept clean catheterization at home. The ifrst effective micturition time was ( 7.80±4.82 ) d, and it took ( 22.20±7.17 ) d to establish a balanced bladder. The effective rate in the reconstruction of a balanced bladder was about 75%. The ratios of voiding and residual urine volume on reflex micturition were obviously improved at the end of the treatment and at half a year after the treatment, which were 4.06±5.21 and 7.51±6.80 respectively. As to the bladder capacity, little change was found before and after the treatment (P>0.05 ). The QOL score was ( 4.35±1.27 ) points before the treatment, which was decreased to ( 2.40±0.99 ) points at the end of the treatment and ( 1.15±2.45 ) points at half a year after the treatment respectively (P<0.05 ). The detection rates of bacteriuria indicators of white blood cell ( WBC ) and bacteria ( BAC ) were obviously reduced from 90% and 80% before the treatment to 65% and 57.9% at the end of the treatment and 40% and 40% at half a year after the treatment respectively (P<0.05 ). The urine colony counts were 82.6% and 92.6% at the end of the treatment and before the treatment respectively, which changed a little (P>0.05 ). However, it was obviously reduced to 50% at half a year after the treatment, and there were statistically signiifcant differences when compared with the count before the treatment (P<0.05 ). Based on the detection rates of urinary tract bleeding index of red blood cell ( RBC ) and B ultrasound images, no obvious change in the hydronephrosis was detected before the treatment, at the end of the treatment and at half a year after the treatment (P>0.05 ).Conclusions The sacral nerve electro-acupuncture stimulation can help the urinary function reconstruction in the patients with NB caused by cauda equina injury, which can promote urination and reduce residual urine volume. When the balanced bladder is established, the infection rate will be effectively reduced and the QOL of the patients will be obviously improved.