Abstract
Purpose
Evaluate if low-frequency bladder vibration (LFBV) combined with clean intermittent catheterization (CIC) alleviated urinary tract infections (UTIs) in spinal cord injury (SCI) patients with neurogenic bladder (NB).
Methods
A single-blind randomized controlled trial was conducted. Patients who developed UTIs while rehabilitating from SCI were enrolled continuously between January 2021 and March 2023 and randomly assigned to the control or the intervention group. Patients in the intervention group received LFBV twice daily (5–10 Hz, 5–10 min each time) for 10 days. The primary endpoint was urinary leucocytes, and various other UTI indexes were also tracked. The follow-up lasted four weeks.
Results
The control group (n = 44) and the intervention group (n = 43) were indistinguishable in the basic patient characteristics. Compared to the control group, the intervention group has significantly higher urinary leucocytes on day 2 and significantly lower urinary leucocytes and urinary bacteria on day 10. Four weeks after LFBV, the intervention group had significantly lower urinary leucocytes and post-void residual volume, fewer signs and symptoms of urinary tract infection, as well as significantly higher urine volume. There was no significant change in urinary red blood cells or occult blood due to LFBV.
Conclusion
Applying LFBV to SCI/NB patients with UTIs is recommended.
Keywords: Neurogenic bladder, Urinary tract infection, Mechanical vibration, Intermittent urethral catheterization, Spinal cord injury
Introduction
Spinal cord injuries (SCI) have significant, lifelong impacts on individuals’ physical and mental health, social well-being, employment, and family life. These injuries lead to temporary or permanent changes in muscle function, sensation, and autonomic function below the level of injury. Globally, the incidence of spinal cord injury (SCI) varies widely, with estimates ranging from 11.5 to 53.4 cases per million people annually [1]. It is more prevalent in certain age groups, particularly among young adults and the elderly [2], and males are more commonly affected than females [3]. Neurogenic bladder (NB), a condition where the normal bladder function is disrupted due to damage to the nervous system, is very common among SCI patients [4]. Currently, nearly 80% of the SCI patients develop bladder dysfunction within one year after injury, and 42% of the SCI/NB patients are hospitalized due to urinary tract infections (UTIs) [5]. In this population, UTIs are the top cause of morbidity and the second cause of mortality [6, 7].
Treating UTIs in SCI patients differs significantly from treating average patients due to the unique challenges posed by NB and other complications. For example, while average patients commonly have symptoms such as dysuria, urgency, frequency, and lower abdominal pain due to UTI, SCI patients may not experience those typical UTI symptoms because of the impaired sensation, and the manifestations may be increased spasticity, autonomic dysreflexia, or changes in urine color and odor instead [8]. Asymptomatic bacteriuria is also common, and it is usually not treated to avoid antibiotic resistance. If the UTI becomes symptomatic, the treatment is guided by urine culture results and local resistance patterns. Bladder irrigation, while not typically used as a routine treatment for UTIs, is commonly used as a specialized intervention for SCI patients. Compared to average patients, SCI patients have a higher risk of severe complications like upper UTI, sepsis, and renal damage [9].
In 1972, Lapides et al. first introduced the concept of intermittent catheterization into the management of NB [10]. It is now widely acknowledged that clean intermittent cannulation (CIC) can effectively improve bladder function and prevent UTIs. However, some studies argued that CIC may also cause urinary calculi, urinary tract stricture, and even lower UTI, although it has the lowest risk of complications [11].During CIC,the pathogenic bacteria of UTIs (e.g., Escherichia coli) are not readily washed away by urine since they can adhere tightly to the epithelial cells of the urinary tract. The urethra is close to the anus, especially for female patients, but the latter hosts abundant pathogenic bacteria, such as E. coli, Enterococcus faecalis, etc. With frequent catheterization, it becomes more likely for pathogenic bacteria to invade the body [12].
Mechanical vibration is a non-invasive therapy that involves the application of vibratory stimuli to the body, either locally or systemically, to achieve therapeutic benefits. It is a versatile and effective approach to improving musculoskeletal health, managing pain, and aiding in rehabilitation [13].Bladder vibration uses low-frequency physical vibrations to stimulate the bladder and the surrounding muscles to enhance bladder function, facilitate urination, and alleviate UTI symptoms.Previous studies have shown that bladder vibration can increase urine output and decrease the post-void residual volume [14]. The therapy improves bladder function by stimulating pelvic floor muscles and alleviating muscle spasms [15].It strengthens normal urination reflexes and enhances nerve conduction and excitability, thus improving the contraction capacity of both distal and proximal bladder muscle groups [16].The vibration increases local blood flow, and the increased transport of oxygen and nutrients contribute to the repair and functional improvement of the bladder tissue [17]. It has also been found that pathogens attached to the bladder epithelial cells and the folds of the inner cell walls can be dislodged by bladder vibration and then be eliminated from the body with urine, which is relatable to bowel cleansing by abdominal vibration [18].
In a pilot study conducted earlier, we assessed the safety and feasibility of low-frequency vibration for alleviating urinary tract infection symptoms in neurogenic bladder patients and noted some promising results. In the current prospective randomized controlled trial, we formally evaluated the effectiveness, clinical feasibility, and safety of bladder vibration for SCI/NB patients with UTIs.
Materials and methods
Patients
Between January 2021 and March 2023, SCI inpatients were enrolled continuously at the rehabilitation department of the First Affiliated Hospital of Soochow University if they (1) had UTIs and (2) could not void themselves but required CIC. Patients were considered to have UTIs if they (1) had a positive urine culture with > 10,000 colony-forming units per milliliter (CFU/mL) and (2) had one or more of the following complaints: urinary incontinence, bladder cramps, sweating, lower abdominal pain, fever, cloudy urine with odor, overfilled bladder, hyperactive autonomic reflexes, general malaise, or sensory discomfort [19]. Patients were excluded if they had urinary stones (assessed by echography at the time of inclusion), had any endo-urinary device (e.g., urinary prosthesis, ureteral stent, etc.), or were unable to report urinary symptoms accurately. During the study, patients were free to drop out at any time, and early termination would also apply if they developed severe complications.
The basic information of each patient included sex, age, level of spinal cord injury, American Spinal Injury Association (ASIA) impairment score, mechanism of injury, bladder irrigation, and antibiotic treatment. The ASIA score ranged from A to D as follows: A, motor-sensory complete; B, motor complete, sensory incomplete; C, motor-sensory incomplete but at least half of the key muscles below the injury level could not move against gravity; D, motor-sensory incomplete and more than half of the key muscles below the injury level could move against gravity.
Study design
The included patients were assigned randomly into two equal groups (i.e., control and intervention), both receiving routine treatment and care but only the latter also receiving low-frequency bladder vibration (LFBV). The randomization used a secure, remote, web-based computer-generated block randomization procedure with a block size of four, and it was stratified by sex (female vs male) and age (< 30 years, 30–60 years, > 60 years).
For both groups, the routine treatment and care for NB included CIC, fluid intake planning, and bladder function training. The CIC took place 4–6 times daily. The genital area was cleaned before and after each session, and the urine volume and color recorded. For fluid intake planning, the patient gradually increased daily fluid consumption under medical guidance to enhance bladder filling. The bladder function training was Kegel exercises that involved the contraction (5–10 s) and relaxation (10 s) of pelvic floor muscles (10–15 times each time, 2–3 sets per day).
The patients in the intervention group received LFBV twice daily (morning and afternoon once each). Specifically, the bladder was firstly drained by CIC to 10%–20% the maximum capacity (measured using the Meco Electronic Devices PBSV3.1 Bladder Scanner). The clinician then used a multi-frequency vibrator to massage the bladder clockwise along the upper part of the patient’s pubic symphysis (Fig. 1). The vibration frequency was 5–10 Hz and the vibration time was 5–10 min. All patients started with a base vibration frequency of 5 Hz and a base vibration time of 5 min, and increments were made at 1 Hz and 1 min if they showed good tolerance. The patients in the control group received sham vibration (1 Hz) with the same duration twice daily as well: The instrument was configured to make a noise that was indistinguishable from the administration of LFBV. The study was single blind: The clinician knew the status of the instrument in operation, but the patients were blinded.
Fig. 1.
Instrument for low-frequency bladder vibration
The primary efficacy endpoint was urine leukocytes, and secondary endpoints included urine bacteria, urine red blood cells, urine fungi, urine occult blood, urine culture strains, bladder capacity, signs and symptoms of UTIs, and adverse events.
Data analysis
Statistical analyses were performed using IBM SPSS Statistics version 25.0. Data were expressed as count (ratio), mean ± standard deviation, or median [first quartile, third quartile] as appropriate. Quantitative data were analyzed using Student’s t-test, and categorical data were analyzed using the chi-square test or one-way analysis of variance (ANOVA). Differences between groups were considered statistically significant when P < 0.05. Generalized estimating equations were used to analyze the differences in the UTI indexes over the short term (10 days of intervention) and long term (up to 4 weeks after the intervention).
Results
Group size
The sample size of the trial was determined from the non-inferiority test formula [20]as follows:
where n1 and n2 are the acceptable minimal group size of the current trial and all other variables were derived from the pilot study. Specifically, Zα/2 is the critical value for the level of significance, Zβ is the threshold value for statistical efficacy, σ is the overall standard deviation, μt is the mean urine leukocyte of the intervention group, μc is the mean urine leukocyte of the control group, and Δ is the clinically significant difference in effect.
The pilot study had 10 patients in two groups and was otherwise identical to the current trial. The mean value of urine leukocytes was 243.3/μL and 237.2/μL for the intervention group and the control group, respectively. The clinically significant difference in effect was Δ = 10/μL. The overall standard deviation was σ = 21.7. Hence, when the confidence interval was 95%, the power of the test was 90%, and the non-response rate was 10%, the minimum acceptable group size of the current trial was n1 = n2 = 42.
Patients
Of the 147 SCI patients at our rehabilitation department and urodynamically diagnosed with NB, 92 were included in this study, and 87 completed (Fig. 2). There was no statistically significant difference between the control group and the intervention group in terms of sex, age, course of disease, area of SCI, injury classification, bladder irrigation, and antibiotic treatment (Table 1).
Fig. 2.
Inclusion of patients
Table 1.
Patient characteristics
| Characteristics | Intervention group (n = 43) | Control group (n = 44) | P value |
|---|---|---|---|
| Age (mean ± SD, years) | 54.5 ± 9.6 | 56.6 ± 8.9 | 0.258 |
| Sex (M/F) | 34/19 | 38/16 | 0.368 |
| Spinal cord injury level | 0.611 | ||
| Cervical cord | 25 (58.1%) | 29 (65.9%) | |
| Thoracic cord | 8 (18.6%) | 5 (11.4%) | |
| Lumbar/cauda | 10 (23.3%) | 10 (22.7%) | |
| History of neurogenic bladder (mean ± SD, months) | 4.1 ± 1.8 | 3.9 ± 1.0 | 0.858 |
| ASIA impairment score | 0.786 | ||
| A | 17 (39.5%) | 14 (31.8%) | |
| B | 5 (11.6%) | 6 (13.6%) | |
| C | 19 (44.2%) | 20 (45.5%) | |
| D | 2 (4.7%) | 4 (9.1%) | |
| Mechanism of injury | 0.735 | ||
| Fall | 20 (46.5%) | 24 (54.5%) | |
| Transport | 13 (30.2%) | 12 (27.3%) | |
| Non-traumatic | 10 (23.3%) | 8 (18.2%) | |
| Bladder irrigation | 27 (62.8%) | 23 (52.3%) | 0.233 |
| Antibiotic treatment | 0.129 | ||
| Oral antibiotics | 11 (25.6%) | 18 (40.9%) | |
| Intravenous antibiotics | 32 (74.4%) | 26 (59.1%) |
Effect of LFVB
Biochemical indexes
Figure 3 shows that over the course of the intervention (10 days in total), the intervention group had a significantly higher (P < 0.05) level of urinary leucocytes on day 2, but the opposite was true on day 10 (P < 0.001). The intervention group also had a significantly lower (P < 0.01) level of urine bacteria on day 10. Table 2 shows that time–group interaction existed for urinary leukocytes (P = 0.005) and urine red blood cells (P = 0.028). During the follow-up (up to 4 weeks), the intervention group has significantly lower (P < 0.05, P < 0.01, or P < 0.001) urinary leucocytes and urine bacteria than the control group at all points in time (Fig. 3). Table 3 shows that time–group interaction existed for urinary leukocytes (P = 0.011) and urine bacteria (P = 0.027).
Fig. 3.
Comparison of UTIs indexes during and after intervention
Table 2.
Comparison of UTI indexes during intervention (n = 87)
| UTI index | Time point† | Intervention Group (n = 43) | Control Group (n = 44) | Group × Time | |
|---|---|---|---|---|---|
| χ2 | P | ||||
| Urinary leukocytes§ | Pre | 180.7 [47.8, 990.9] | 153.8 [40.0, 644.2] | 12.912 | 0.005 |
| D2 | 700.7 [213.5, 1833.5]* | 341.9 [24.3, 732.5] | |||
| D5 | 152.1 [54.7, 1253.8] | 206.3 [25.4, 722.2] | |||
| D10 | 18.4 [5.4, 78.4]*** | 232.3 [105.6, 831.1] | |||
| Urine red blood cells§ | Pre | 22.7 [0, 130.9] | 67.6 [11.4, 197.1] | 9.121 | 0.028 |
| D2 | 23.1 [6.6, 61.9] | 24.4 [0, 63.4] | |||
| D5 | 27.0 [0, 97.4] | 9.6 [0, 38.0] | |||
| D10 | 8.1 [0, 25.8] | 15.2 [0, 46.7] | |||
| Urine bacteria§ | Pre | 76.1 [25.0, 595.5] | 119.9 [5.2, 996.8] | 4.706 | 0.195 |
| D2 | 492.9 [78.3, 1109.4] | 90.0 [0, 1106.8] | |||
| D5 | 452.9 [33.5, 1580.5] | 113.0 [0, 915.4] | |||
| D10 | 0 [0, 35.8]** | 245.7 [0, 1035.5] | |||
| Urinary fungi§ | Pre | 0 [0, 53.2] | 0 [0, 0] | 5.216 | 0.157 |
| D2 | 0 [0, 0] | 0 [0, 0] | |||
| D5 | 0 [0, 0] | 0 [0, 0] | |||
| D10 | 0 [0, 0] | 0 [0, 0] | |||
| Urine occult blood¶ | Pre | 35 (81.4%) | 36 (81.8%) | 3.078 | 0.380 |
| D2 | 35 (81.4%) | 36 (81.8%) | |||
| D5 | 27 (62.8%) | 34 (77.3%) | |||
| D10 | 19 (44.2%) | 32 (72.7%) | |||
† Pre, before intervention; D2, after intervention for 2 days; D5, after intervention for 5 days; D10, after intervention for 10 days. §Unit: cells per microliter. Expressed as median [first quartile, third quartile].Expressed as count (ratio)
*P < 0.05, **P < 0.01, ***P < 0.001 compared to the control group in the same stage
Table 3.
Comparison of UTI indexes after intervention (n = 87)
| UTI index | Time† | Intervention group(n = 43) | Control group(n = 44) | Group × Time | |
|---|---|---|---|---|---|
| χ2 | P | ||||
| Urinary leukocytes§ | Pre | 180.7 [47.8, 990.9] | 153.8 [40.0, 644.2] | 12.988 | 0.011 |
| W1 | 20.0 [5.7, 86.9]** | 111.0 [48.5, 496.0] | |||
| W2 | 14.0 [0, 46.9]** | 82.0 [15.8, 1951.5] | |||
| W3 | 6.7 [0, 37.6]*** | 293.3 [26.3, 1040.3] | |||
| W4 | 8.7 [0, 17.2]*** | 186.3 [70.2, 627.1] | |||
| Urine red blood cells§ | Pre | 22.7 [0, 130.9] | 67.6 [11.4, 197.1] | 4.375 | 0.358 |
| W1 | 0 [0, 27.4] | 3.2 [0, 27.2] | |||
| W2 | 0 [0, 4.8] | 0 [0, 76.0] | |||
| W3 | 0 [0, 9.6] | 0 [0, 98.3] | |||
| W4 | 0 [0, 4.6] | 0 [0, 3.6] | |||
| Urine bacteria§ | Pre | 76.1 [25.0, 595.5] | 119.9 [5.2, 996.8] | 10.971 | 0.027 |
| W1 | 0 [0, 27.6]** | 50.7 [0, 1160.5] | |||
| W2 | 0 [0, 44.3]* | 119.1 [0, 1813.7] | |||
| W3 | 0 [0, 6.5]* | 32.7 [0, 234.6] | |||
| W4 | 0 [0, 0]** | 91.8 [0, 862.8] | |||
| Urinary fungi§ | Pre | 0 [0, 53.2] | 0 [0, 0] | 6.27 | 0.180 |
| W1 | 0 [0, 0] | 0 [0, 0] | |||
| W2 | 0 [0, 0] | 0 [0, 0] | |||
| W3 | 0 [0, 0] | 0 [0, 0] | |||
| W4 | 0 [0, 0] | 0 [0, 0] | |||
| Urine occult blood¶ | Pre | 35 (81.4%) | 36 (81.8%) | 3.347 | 0.501 |
| W1 | 19 (44.2%) | 28 (63.6%) | |||
| W2 | 15 (34.9%)* | 30 (68.2%) | |||
| W3 | 17 (39.5%) | 30 (68.2%) | |||
| W4 | 13 (30.2%) | 24 (54.5%) | |||
†Pre, before intervention; W1, follow-up at 1 week; W2, follow-up at 2 weeks; W3, follow-up at 3 weeks; W4, follow-up at 4 weeks. § Unit: cells per microliter. Expressed as median [first quartile, third quartile]. Expressed as count (ratio)
* P < 0.05, **P < 0.01, ***P < 0.001 compared to the control group in the same stage
Urine cultures, bladder capacity, and UTIs symptoms
Table 4 shows that four weeks after LFBV, compared to the control group, fewer patients in the intervention group had urine cultures of Gram-negative strains (33.3% vs. 59.1%, P = 0.04). At this time, the intervention group also had significantly higher urine volume (388.6 ± 35.1 vs. 349.5 ± 29.7, P = 0.008) and significantly lower post-void residual volume (161.5 ± 49.2 vs. 193.8 ± 53.2, P = 0.001). In addition, fewer patients experienced UTI symptoms both immediately and four weeks after LFBV (P < 0.05). Time–group interaction existed for urine cultures, post-void residual volume, and urine volume.
Table 4.
Urine cultures, bladder capacity, and infection symptoms of different groups
| Variables | Intervention Group (n = 43) | Control Group (n = 44) | Group × Time | |||||
|---|---|---|---|---|---|---|---|---|
| Pre† | D10† | W4† | Pre† | D10† | W4† | χ2 | P | |
| Urine cultures | ||||||||
| Gram-negative strains | 29 (71.4%) | 27 (66.7%) | 13 (33.3%)* | 32 (72.7%) | 32 (72.7%) | 26 (59.1%) | 6.454 | 0.040 |
| Gram-positive strains | 7 (19.0%) | 7 (19.0%) | 3 (9.5%) | 10 (22.7%) | 8 (18.2%) | 4 (9.1%) | ||
| Fungi | 3 (9.5%) | 2 (4.8%) | 0 (0%) | 2 (4.5%) | 2 (4.5%) | 2 (4.5%) | ||
| Bladder capacity (mL) | ||||||||
| Post-void residual volume | 240.8 ± 55.6 | 220.0 ± 50.6 | 161.5 ± 49.2* | 238.5 ± 59.5 | 216.4 ± 60.1 | 193.8 ± 53.2 | 14.038 | 0.001 |
| Urine volume | 315.5 ± 34.5 | 326.9 ± 33.0 | 388.6 ± 35.1* | 309.4 ± 34.1 | 318.8 ± 35.9 | 349.5 ± 29.7 | 99.676 | 0.008 |
| UTIs Symptoms | ||||||||
| None | 0 (0%) | 28 (65.1%)* | 36 (83.7%)* | 0 (0%) | 12 (27.3%) | 24 (54.5%) | 4.673 | 0.097 |
| 1 | 0 (0%) | 10 (23.3%) | 7 (16.3%) | 0 (0%) | 14 (31.8%) | 12 (27.3%) | ||
| 2 | 30 (69.8%) | 5 (11.6%) | 0 (0%) | 28 (63.6%) | 18 (40.9%) | 8 (18.2%) | ||
| ≥ 3 | 13 (30.2%) | 0 (0%) | 0 (0%) | 16 (36.4%) | 0 (0%) | 0 (0%) | ||
†Pre, before intervention; D10, at the end of the intervention; W4, 4 weeks after the intervention
*P < 0.05 compared to the control group in the same stage
Safety
Throughout the trial, no signs or symptoms of overflow incontinence occurred to any patient during or after LFBV, and no patients reported any side effects.
Discussion
Research indicates that low-frequency vibration can improve bone mineral density, enhance nerve function, and strengthen muscles [21, 22]. Some studies applied whole-body vibration at frequencies up to 50 Hz to treat SCI patients with complications such as osteoporosis [23]. A frequency of 5 Hz is close to the threshold for nerve and muscle activity [24], and it is considered moderate as it provides effective mechanical stimulation without causing excessive fatigue or discomfort. In this work, we selected 5 Hz as the starting frequency of LFBV and gradually increased the frequency when patients showed tolerance and no adverse reactions. The vibration time was set to 5–10 min after reviewing the literature and consulting experts, which ensured both safety and effectiveness. No subject developed any new UTIs symptoms during the study, and the LFBV did not significantly increase the count of urinary red blood cells or the occurrence of urinary occult blood. Hence, the LFBV did not damage the bladder mucosa [25].
Both Gram-negative (e.g., E. coli) and Gram-positive bacteria (e.g., E. faecalis) are common UTI pathogens, and the incidence of UTI due to fungi has also been increasing [26]. Urinary bacterial culture is the gold standard for diagnosing UTIs, but it precludes rapid diagnosis because of its long turnaround time as well as higher cost. In contrast, urine leukocytes are a key indicator of UTIs that offer significant clinical value because quick assessments can be made at low cost. Since this study is a preliminary exploration of the safety and effectiveness of LFBV in alleviating UTIs in SCI/NB patients, we selected urine leukocytes as the primary endpoint. After LFBV, the intervention group had significantly lower urinary leukocytes and urinary bacteria than the control group for up to four weeks. The urinary occult blood was also significantly reduced two weeks after the intervention. Hence, LFBV was able to relieve UTIs in SCI/NB patients in a sustained manner well after the treatment was complete.
Patients with NB exhibit very different signs and symptoms of UTIs depending on the underlying pathology and the extent of the injury [27]. The most prevalent clinical signs, either alone or in combination, were cloudy and/or foul-smelling urine (51.4%), onset of urinary incontinence (51.2%), fatigue or restlessness (41.7%), fever (30.7%), and increased cramping (30.2%) [28]. Studies have shown greater variability in outcomes between signs and symptoms in predicting UTIs in the NB population [28, 29]. The Infectious Diseases Society of America suggests that unique neurogenic symptoms, i.e., autonomic dysreflexia, increased spasticity, or restlessness, may suggest a catheter-associated UTI [30]. Therefore, being aware of these signs and symptoms is important for physicians to detect UTIs timely. In this study, signs or symptoms of urinary tract infection were significantly reduced in the intervention group compared to the control group at the end of the treatment and 4 weeks after the treatment (P < 0.05).
Patients with NB often have detrusor overactivity or detrusor sphincter dyssynergia, which significantly increase the bladder pressure and the post-void residual volume [31]. The vibration therapy can somewhat relieve the smooth muscle spasms caused by central nervous system disorders to reduce bladder pressure [32, 33]. In this study, at four weeks after LFBV, the intervention group had significantly higher urine volume (P < 0.05) and significant lower post-void residual volume (P < 0.05). In addition, high bladder pressure or organ hyperinflation reduces the blood flow into the bladder, and the resulting ischemia of the bladder tissue expedites the invasion of pathogens. Previous studies suggested that E. coli is the most predominant pathogenic species of UTIs [34]. In this study, the detection rate of Gram-negative strains dropped significantly after LFBV, although the detection rates of Gram-positive bacteria and fungi were unaffected. Taken together, LFBV improved the contraction of the detrusor muscle, reduced bladder pressure, increased the urine volume, and alleviated UTIs.
The limitations of this work are as follows. First, this is a single-center study, and the results may not be completely generalizable. Second, we used urinary leukocytes as a convenient primary endpoint, and future studies will benefit from using urinary cultures to strengthen the conclusions. Moreover, the key parameters of the bladder vibration protocol, including vibration frequency, duration, and time of intervention, may be finetuned further to obtain better results.
Conclusions
Low-frequency bladder vibration was a beneficial intervention in SCI/NB patients who developed UTIs. After receiving bladder vibration at 5–10 Hz twice a day (5–10 min each time) for 10 days, the patients had significantly lower urinary leukocytes, significantly higher urine volume, and significantly lower post-void residual volume. The improvements were sustained up to four weeks after the intervention. It may be helpful to incorporate bladder vibration into the standard rehabilitation protocol for SCI patients.
Acknowledgements
This work was supported by the National Natural Science Foundation of China (Grant No.82270787) and The 33rd Batch of Suzhou Science and Technology Development Program Projects (Grant No. SZM2022020).
Author contributions
YZ, experimentation, data collection, data analysis, writing – first draft; PC, experimentation, data collection; XF, experimentation; QY, conception, funding acquisition; HW, conception, funding acquisition. All authors have approved the final version.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Conflict of interest
The authors declare no competing interests.
Ethical approval
The study was conducted in accordance with the World Medical Association Declaration of Helsinki and the Guideline for Good Clinical Practice. The study protocol was approved by the institutional ethics committee (No. 2018206) and all the participants provided their written informed consent.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Yingying Zhang and Ping Cai contributed equally to this work.
Contributor Information
Qian Yang, Email: yangq217@126.com.
Haifang Wang, Email: wanghaifang2668@163.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No datasets were generated or analysed during the current study.