Author Year
Country
Score
Research Design
Total Sample Size

Methods

Outcome

• Desmopressin acetate (DDAVP)

Zahariou et al. 2007
Greece
Downs & Black score=20
Pre-post
N=11

Population: SCI in inpatient rehabilitation: Gender: males = 7, females = 4; Level of injury: above T6 = 6, below T6 = 5.
Treatment: DDAVP was given intranasally (20µg before bedtime) in association with other standard therapy including anticholignergic drugs (oxybutynin 5mg, 1x3 daily), evening antibiotic prophylaxis and CIC. 
Outcome Measures: Urine production / output, CIC rate. Urine samples collected at 6 am and 6pm. 

• Desmopressin produced a statistically significant increase in urine production rate during the day (p<0.001) and a decrease in nocturnal urine production (p<0.001).
• Desmopressin treatment showed a significant increase on urine asmolarity during the night (p<0.001).
• Treatment produced a significant decrease in patients performing clean intermittent catheterizations in the night while still maintaining continence.
• No serious adverse effects were seen.

Chancellor et al. 1994 USA
Downs & Black score=6
Case Series
N=7

Population: SCI with detrusor hyperreflexia unresponsive to conventional therapy: Age = 22-52 yrs; Gender: males = 3, females = 4.
Treatment: 10ug/day intranasal DDAVP over 1 month.
Outcome Measures: Episodes of nocturia, time between catheterizations.

• No statistical results reported.
• Decreased nocturia for 4 patients treated at night (Nocturnal enuresis eliminated in 2 patients).
• Increased duration between catheterizations for 3 patients treated during the day.

Electroacupunture

Cheng et al. 1998 Taiwan
PEDro=4
RCT
N=60

Population: SCI: Acupuncture vs Control Group; Mean age = 39.4 vs 34.3 yrs; Gender (M/F): 24/8 vs 23/5; Level of injury: above T11 = 34, below T11 = 26; Severity of injury: Frankel A = 25, B = 35; Time since injury = 23.7 vs 26.1 days.
Treatment: Electroacupuncture to 4 points (CV3,CV4,UB32 bilateral) + conventional bladder training (n=32) vs control group of conventional bladder training only (n=28).
Outcome Measures: Time from SCI-bladder balanced, urodynamic assessment in n=20 of acupuncture group.

• ↓ time to achieve bladder balancing for those with upper motor lesions - acupuncture vs control, 57.1±22.5 vs 85.2±27.4 days (p<0.005).
• Similar for lower motor neuron lesions, 55.4± 22.6 vs 83.4 ±26.1 days (p<0.01).
• If it was started within 3 weeks of SCI, bladder balancing was achieved sooner, 46.6±13.2 vs 65.8±15.4 days (p<0.005).
• No significant changes seen in urodynamic assessment associated with 1st acupuncture session but ↑ in bladder capacity and ↓ voiding pressure seen by time bladder was balanced.

Nerve Crossover Surgery - Spinal Root Anastomoses

Livshits et al. 2004
Israel/Russia
Downs & Black score=18
Case series
N=11

Population: SCI with neurogenic bladder: Mean age = 30y; Gender: males = 11; Severity of injury: complete = 11; Level of injury = L1; Mean time since injury = 2y; Mean follow up time = 1 y.
Treatment: Patients underwent nerve crossover surgery (11th and 12th intercostals nerves anastomosed to S2-S3 roots) for urinary bladder reinnervation in chronic stage of SCI.
Outcome Measures: Bladder capacity, urine volume, residial urine volume, detrusor tone, voiding pressure, force of detrusor condition, and sphincter resistance were measured before and 1 year after surgery.

• Significant changes were seen in all parameters of bladder function from pre to post operation (p=0.003):
  • Bladder capacity ↓, urine volume ↑, residual urine volume ↓, detrusor tone ↑, voiding pressure ↑, force of detrusor condition ↑, sphincter resistance ↑.
• In most patients, the reappearance of bulbocavernous, anal and cremasteric reflexes were seen.

Lin et al. 2008
China
D&B=20
Pre-Post
N=10

Population: Complete conus medullaris injury with atonic bladder; Mean age=38yrs; Gender: males=6, females=4; Level of injury: T12=3, L1=5, L2=4; Severity of injury: complete
Treatment: Spinal root anastomosis of T11 to S2 ventral root.
Outcome Measures: Bladder capacity, urine volume, residual urine volume, max detrusor pressure, max flow collected at regular intervals up to 2 years.

• 70% of patients found improvements in bladder storage and voiding functions.
• Signficant improvement in urodynamic outcomes were seen 2 years post reconstruction:
• Bladder capacity, p=0.0031
• Urine volume, p=0.0026
• Residial urine volume, p=0.0005
• Max detrusor pressure, p=0.00001
• Max flow, p=0.0001
• Mild postoperative spinal fluid leakage was seen in 1 patient.

Xiao et al. 2003
China/USA
D&B=18
Pre-Post
N=15

Population: SCI patients with DESD; Mean age=39; Severity of injury: AIS A
Treatment: L5-S3 ventral root anastomosis to establish a new reflex pathway.
Outcome Measures: Residual urine volume, urinary tract infections, detrusor pressure, adverse events.

• 67% of patients had recovery of bladder storage and emptying functions.
• A decrease was seen in average residual urine (332 to 31 ml) and incidence of urinary tract infections 8 months post surgery.
• Two patients were still dependent on a stimulator for voiding.
• Post surgery, 4 patients showed almost normal bladder activity on a CMG and EMG.
• Significant improvement was seen in mean detrusor pressure (p<0.05).
• 3 patients had mild postoperative spinal fluid leakage for 2 to 5 days.
• Bowel control was also regained in individuals who regained bladder control.

Lin et al. 2009
China
D&B=16
Pre-Post
N=12

Population: SCI patients with DESD; Mean age=30yrs; Gender: males=8, females=4; Level of injury: C=2, T=10
Treatment: Spinal root anastomosis of S1 to S2 ventral root.
Outcome Measures: Incontinence, bladder capacity, flow rate, UTI, adverse events and were followed for up to 6 years (mean = 3 years).

• 75% of patients had recovery of bladder storage without nocturnal urinary incontinence.
• An increase was seen in average bladder capacity (p=0.0011) and maximum flow rate (p=0.0002) postsurgery.
• Residual urine (p=0.0004) and maximum detrusor pressure (p=0.0435) decreased post surgery.
• At 6 month post surgery, incidence of urinary tract infections stopped.
• Adverse effects included CSF leakage and headache.