Introduction: Stroke survivors often experience lower urinary tract dysfunction that can be difficult to treat and profoundly impacts their quality of life. After a stroke, micturition-associated brain activity (MABA) has been shown to rely on activation of primitive brain regions including the cerebellum and periaqueductal gray with less activation of cortical regions. Transcutaneous Spinal Cord Stimulation (TSCS), a novel technique of neuromodulation, is emerging as a powerful tool with growing clinical evidence in neuro-restoration potential. The objective was to evaluate changes in brain activity using functional MRI (fMRI) and patient reported outcome measures (PROM) following twelve weeks of TSCS. Methods: Twelve patients with de novo lower urinary tract symptoms following a stroke prospectively underwent TSCS for 24 sessions. Blood oxygen level dependent (BOLD) brain activity changes detected with fMRI were collected during maximum urgency, measured 10 seconds prior to detrusor contraction. Patients completed a voiding diary, ICIQ-OAB questionnaire, and underwent fMRI + UDS before and after TSCS. Descriptive statistics and paired t-test were used when appropriate. Results: Twelve patients (5 males, 7 females) with a mean age of 52.8 ± 9.8 years old completed the study. After completion of TSCS, patients reported a decreased perception of urge per void (1.83 ± 0.34 vs 0.92 ± 0.21: p<0.05), number of urge incontinence episodes (6.96 ± 2.12 vs 4.15 ± 1.58: p > <0.05), and an increased number of urge-free voids per 24 hours (0.27 ± 0.09 vs 2.29 ± 0.91; p<0.05). ICIQ-OAB scores were significantly lower post stimulation (9.6 vs 4.1; p=0.001). Functional MRI detected an increase in BOLD signal in the cerebellum, cuneus, and multiple frontal areas including the inferior, medial, and middle frontal gyri following TSCS. Conclusions: Patients that completed twelve weeks of TSCS experienced a significant reduction in perceived urge per void and urgency incontinence episodes and an increase in urge-free voids per 24 hours. ICIQ-OAB scores were significantly lower in patient’s post-spinal neuromodulation. TSCS resulted in a restoration of activation of several cortical brain regions. SOURCE OF Funding: Urology Care Foundation
