Introduction: Reduction of urinary urgency and incontinence is a top priority for individuals with neurogenic bladder (NB). Multiple clinical studies show non-invasive genital nerve stimulation (GNS) can modulate sympathetic reflexes to inhibit bladder contractions acutely and is well-tolerated. To translate GNS as an effective adjunct therapy for managing neurogenic bladder, further evidence of chronic efficacy and feasibility is needed. Methods: In this “before-and-after” prospective cohort study, participants acted as their own controls. 9 individuals with NB were enrolled (8/9 (88.9%) male) and confirmed to: 1) have NB by urodynamics examination and 2) have bladder contractions inhibited by GNS. 5 participants (100% male) who tolerated GNS without additional medications and were adherent to voiding diaries tested the efficacy of at-home, self-administered GNS using a commercial TENS unit. Participants completed voiding diaries, each detailing at least 1 continuous week of tracked voiding, leak, and urgency events. Diaries were completed once at study initiation during a control period without GNS or medications, and then for 3 separate periods during prolonged use of GNS to manage incontinence (baseline, 6 months, 1 year). Participants also completed a bladder-related quality of life questionnaire (Qualiveen) at their initial evaluation, as well as 6 and 12 months later. Results: Preliminary findings show that GNS increased bladder capacity for all 9 individuals tested by an average of 58%, and 3/5 individuals tested chronically maintained an increased bladder capacity after 6 months of GNS. 4/5 individuals reported increased bladder-related QOL by total Qualiveen after 6 months of at-home GNS. Of 2 individuals who experienced leakage with chronic voiding data one reduced their leaks/day by 90% at 6 months of use and the other by 30% at 1 year of GNS. Of 2 individuals with the primary goal of reducing bladder urgency, neither was able to reduce their urgency events/day but were able to reduce their voiding frequency by 65% and 15% after more than 1 month of use. The primary reason individuals reported for dropping from the study was difficulty placing the electrodes and keeping them in place. Conclusions: GNS can provide a durable reduction in leakage events for individuals with incontinence due to neurogenic bladder up to 6 months. Multiple subjects reported issues with electrode placement and adhesion as well as associated wires from the TENS unit leading to less-than-ideal GNS for some. SOURCE OF Funding: - RX002512 Department of Veterans Affairs - 642810 Craig H. Neilsen Foundation (CHNF)
