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These organs are under control of supraspinal, spinal, and peripheral innervation. Micturition requires coordination of the urinary bladder, whose role is urine storage, and the bladder neck, urethra, and urethral sphincters, which provide the outlet through which voiding occurs. The purpose of this review is to explore the current research regarding the use of spinal cord stimulation (SCS) as a therapy for bladder dysfunction after SCI. Mortality due to urological dysfunction has decreased in recent decades (3% of SCI deaths) due to increases in treatment options however, these treatment options are not well-tolerated by persons with SCI, and restoration of bladder function remains a challenge following SCI. DSD leads to high bladder pressures, which may result in vesicoureteral reflux, leading to kidney damage. DSD results from discoordinated simultaneous contraction of the detrusor and external urethral sphincter. NDO occurs as involuntary bladder contractions during filling and can occur at low volumes and lead to incontinence. In persons with SCI, bladder dysfunction includes neurogenic detrusor overactivity (NDO) and/or detrusor sphincter dyssynergia (DSD). In addition to motor impairment, SCI causes autonomic and sensory deficits, including bladder dysfunction.
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In the United States, over 288,000 people live with spinal cord injuries (SCIs), and ∼17,700 new cases of SCI are reported annually. However, the effective stimulation parameters and the appropriate timing and location of stimulation for SCS-mediated restoration of bladder function require further study, and studies are needed to determine underlying mechanisms of action. Further, SCS is a well-developed therapy for chronic pain, and existing Food And Drug Administration (FDA)-approved devices provide a clear pathway to sustainable commercial availability and impact. Improvements include increased volitional voiding, voided volumes, bladder capacity, and quality of life, as well as decreases in NDO and DSD. Improvements in bladder function following SCI have been documented using a number of different modalities of spinal cord stimulation (SCS) in both persons with SCI and animal models, including SCS alone or SCS with concomitant activity-based training. Current approaches to treat bladder dysfunction in persons with SCI, including self-catheterisation and anticholinergic medications, are inadequate, and novel approaches are required to restore continence with increased bladder capacity, as well as to provide predictable and efficient on-demand voiding. Spinal cord injury (SCI) results in the inability to empty the bladder voluntarily, and neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD) negatively impact both the health and quality of life of persons with SCI.