1
|
Douven P, Tilborghs S, van de Borne S, van Koeveringe GA, de Wachter S. Burst Stimulation Evokes Increased Bladder and Urethral Pressure in Patients With Sacral Neuromodulation, Indicating Potential Activation of the Autonomic Nervous System: A Pilot Study. Neuromodulation 2024:S1094-7159(24)00647-0. [PMID: 39093261 DOI: 10.1016/j.neurom.2024.06.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES Currently, sacral neuromodulation (SNM) outcomes are often suboptimal, and changing stimulation parameters might improve SNM efficacy. Burst stimulation mimics physiological burst firing of the nervous system and might therefore benefit patients treated with SNM. The purpose of the present pilot study was to evaluate the effect of various Burst SNM paradigms on bladder and urethral pressure in patients with overactive bladder (OAB) or nonobstructive urinary retention (NOUR). MATERIALS AND METHODS The bladder was filled to 50% of its capacity under general anesthesia in six patients with an implanted sacral lead for SNM purposes. Bladder pressure, and mid- and proximal urethral pressure were measured using conventional (Con-) SNM and various Burst SNM paradigms (10-20-40 Hz interburst frequency) with increasing amplitudes up to 5 mA for Con-SNM and 4 mA for Burst SNM. RESULTS Burst SNM caused a substantial increase in both bladder and urethral pressure. In contrast, Con-SNM caused a milder increase in urethral pressure, and only one patient showed a modest increase in bladder pressure. Furthermore, the pressure increase was higher in the proximal urethra than in the midurethra using Burst-SNM, whereas Con-SNM caused comparable increases in proximal and midurethra pressure. CONCLUSIONS Burst SNM induces bladder contraction compared with Con-SNM and induces higher pressure increases in bladder and proximal urethra than does Con-SNM in patients with OAB or NOUR, indicating a higher degree of autonomic nervous system stimulation. The observed responses could not be fully explained by the total charge of the Burst SNM paradigms, which suggests the importance of individual Burst SNM parameters, such as frequency and amplitude. Future studies should assess the feasibility and efficacy of Burst SNM in awake patients.
Collapse
Affiliation(s)
- Perla Douven
- Department of Urology, Maastricht University Medical Center, The Netherlands; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| | - Sam Tilborghs
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Belgium
| | - Sigrid van de Borne
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Belgium
| | - Gommert A van Koeveringe
- Department of Urology, Maastricht University Medical Center, The Netherlands; Department of Translational Neuroscience, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| | - Stefan de Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Belgium.
| |
Collapse
|
2
|
Islam S, Gulati RK, Domic M, Pal A, Kant K, Kim A. Performance Evaluation of Magnetic Resonance Coupling Method for Intra-Body Network (IBNet). IEEE Trans Biomed Eng 2021; 69:1901-1908. [PMID: 34818185 DOI: 10.1109/tbme.2021.3130408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Effective management of emerging medical devices can lead to new insights in healthcare. Thus, a human body communication (HBC) is becoming increasingly important. In this paper, we present magnetic resonance (MR) coupling as a promising method for intra-body network (IBNet). The study reveals that MR coupling can effectively send or receive signals in biological tissue, with a maximum path loss of PL 33 dB (i.e. at 13.56 MHz), which is lower than other methods (e.g., galvanic, capacitive, or RF) for the same distance. The angular orientation of the transmitter and receiver coils at short and long distances also show a minor variation of the path loss (0.19 PL 0.62 dB), but more dependency on the distance (0.0547 dB/cm). Additionally, different postures during the MR coupling essentially do not affect path loss (PL 0.21 dB). In the multi-nodal transmission scenario, the MR coupling demonstrates that two nodes can simultaneously receive signals with -16.77 dBm loss at 60 cm and 100 cm distances, respectively. Such multi-node MR transmission can be utilized for communication, sensing, and powering wearable and implantable devices.
Collapse
|
3
|
Yousefpour A, Erfanian A. A general framework for automatic closed-loop control of bladder voiding induced by intraspinal microstimulation in rats. Sci Rep 2021; 11:3424. [PMID: 33564019 PMCID: PMC7873267 DOI: 10.1038/s41598-021-82933-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
Individuals with spinal cord injury or neurological disorders have problems in voiding function due to the dyssynergic contraction of the urethral sphincter. Here, we introduce a closed-loop control of intraspinal microstimulation (ISMS) for efficient bladder voiding. The strategy is based on asynchronous two-electrode ISMS with combined pulse-amplitude and pulse-frequency modulation without requiring rhizotomy, neurotomy, or high-frequency blocking. Intermittent stimulation is alternately applied to the two electrodes that are implanted in the S2 lateral ventral horn and S1 dorsal gray commissure, to excite the bladder motoneurons and to inhibit the urethral sphincter motoneurons. Asynchronous stimulation would lead to reduce the net electric field and to maximize the selective stimulation. The proposed closed-loop system attains a highly voiding efficiency of 77.2-100%, with an average of 91.28 ± 8.4%. This work represents a promising approach to the development of a natural and robust motor neuroprosthesis device for restoring bladder functions.
Collapse
Affiliation(s)
- Abolhasan Yousefpour
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran
| | - Abbas Erfanian
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran.
| |
Collapse
|
4
|
Malot C, Chesnel C, Hentzen C, Haddad R, Miget G, Grasland M, Le Breton F, Amarenco G. [Urethral reflexes: A review]. Prog Urol 2020; 31:651-662. [PMID: 33250359 DOI: 10.1016/j.purol.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 07/21/2020] [Accepted: 10/08/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The urethrosphincter complex is involved not only in maintaining urinary continence, particularly during effort, but also for the achievement of a complete and effective micturition. Indeed, the urethra is not a simple passive channel for the evacuation of urine from the bladder to the urethral meatus, since its resistive capacities and its possibilities of modulation of the micturition reflex depend on its reflex role either as a sensory afferent or as a neuro-muscular effector. It also participates in many genito-sexual and ano-rectal réflexes. MATERIAL AND METHOD This review of the literature describes the various reflexes of the urethra as a sensory stimulus or a neuromuscular effector. All articles referenced in this review were obtained from articles indexed on Pubmed-Medline, using the keywords: "urethral reflexes; "reflex bladder"; "urination reflex"; "intravaginal; vaginal"; "anorectal; sphincter"; "Storage and voiding"; "reflexes sneezing"; "cough reflex". Other articles were selected through references of the articles issued from the first research. Only articles in English and French have been selected. The articles concerned animal and human experiments. RESULTS Eight hundred and sixty-four referenced articles were founded and a total of 75 articles were included, describing the various reflexes mediated by the urethra acting as a sensory afferent or mechanical effector. We differentiated the known data in humans and animals. CONCLUSION The urethra is a complex anatomical structure ensuring, through numerous reflex mechanisms, urinary continence. Urethral resistances are modulated during efforts and depends on the bladder capacity and the intensity of the efforts. During micturition, the coordination between the bladder and the urethra is mediated by reflex pathways organized at the cerebral, spinal and lumbosacral levels. The modulation of the micturition in term of efficacy and velocity, is due in part, to the re-afferentation of the spinal reflex by continuous stimulus of the urethral canal. Many of these reflexes are imperfectly described. Finally, the urethra is implicated in reflex loops of anal continence and sexual functions.
Collapse
Affiliation(s)
- C Malot
- Hôpital Tenon, Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, 75020 Paris, France
| | - C Chesnel
- Hôpital Tenon, Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, 75020 Paris, France
| | - C Hentzen
- Hôpital Tenon, Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, 75020 Paris, France
| | - R Haddad
- Hôpital Tenon, Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, 75020 Paris, France
| | - G Miget
- Hôpital Tenon, Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, 75020 Paris, France
| | - M Grasland
- Hôpital Tenon, Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, 75020 Paris, France
| | - F Le Breton
- Hôpital Tenon, Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, 75020 Paris, France
| | - G Amarenco
- Hôpital Tenon, Sorbonne université, GRC 001, GREEN groupe de recherche clinique en neuro-urologie, AP-HP, 75020 Paris, France.
| |
Collapse
|
5
|
Xu JJ, Yousuf Z, Ouyang Z, Kennedy E, Lester PA, Martin T, Bruns TM. Anesthetic agents affect urodynamic parameters and anesthetic depth at doses necessary to facilitate preclinical testing in felines. Sci Rep 2020; 10:11401. [PMID: 32647241 PMCID: PMC7347647 DOI: 10.1038/s41598-020-68395-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/22/2020] [Indexed: 01/23/2023] Open
Abstract
Urodynamic studies, used to understand bladder function, diagnose bladder disease, and develop treatments for dysfunctions, are ideally performed with awake subjects. However, in small and medium-sized animal models, anesthesia is often required for these procedures and can be a research confounder. This study compared the effects of select survival agents (dexmedetomidine, alfaxalone, and propofol) on urodynamic (Δpressure, bladder capacity, bladder compliance, non-voiding contractions, bladder pressure slopes) and anesthetic (change in heart rate [∆HR], average heart rate [HR], reflexes, induction/recovery times) parameters in repeated cystometrograms across five adult male cats. The urodynamic parameters under isoflurane and α-chloralose were also examined in terminal procedures for four cats. Δpressure was greatest with propofol, bladder capacity was highest with α-chloralose, non-voiding contractions were greatest with α-chloralose. Propofol and dexmedetomidine had the highest bladder pressure slopes during the initial and final portions of the cystometrograms respectively. Cats progressed to a deeper plane of anesthesia (lower HR, smaller ΔHR, decreased reflexes) under dexmedetomidine, compared to propofol and alfaxalone. Time to induction was shortest with propofol, and time to recovery was shortest with dexmedetomidine. These agent-specific differences in urodynamic and anesthetic parameters in cats will facilitate appropriate study-specific anesthetic choices.
Collapse
Affiliation(s)
- Jiajie Jessica Xu
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Zuha Yousuf
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Zhonghua Ouyang
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Eric Kennedy
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Patrick A Lester
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tara Martin
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tim M Bruns
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA. .,Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA.
| |
Collapse
|
6
|
Yan D, Bruns TM, Wu Y, Zimmerman LL, Stephan C, Cameron AP, Yoon E, Seymour JP. Ultracompliant Carbon Nanotube Direct Bladder Device. Adv Healthc Mater 2019; 8:e1900477. [PMID: 31556241 PMCID: PMC6893921 DOI: 10.1002/adhm.201900477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/08/2019] [Indexed: 12/20/2022]
Abstract
The bladder, stomach, intestines, heart, and lungs all move dynamically to achieve their purpose. A long-term implantable device that can attach onto an organ, sense its movement, and deliver current to modify the organ function would be useful in many therapeutic applications. The bladder, for example, can suffer from incomplete contractions that result in urinary retention with patients requiring catheterization. Those affected may benefit from a combination of a strain sensor and electrical stimulator to better control bladder emptying. The materials and design of such a device made from thin layer carbon nanotube (CNT) and Ecoflex 00-50 are described and demonstrate its function with in vivo feline bladders. During bench-top characterization, the resistive and capacitive sensors exhibit stability throughout 5000 stretching cycles under physiology conditions. In vivo measurements with piezoresistive devices show a high correlation between sensor resistance and volume. Stimulation driven from platinum-silicone composite electrodes successfully induce bladder contraction. A method for reliable connection and packaging of medical grade wire to the CNT device is also presented. This work is an important step toward the translation of low-durometer elastomers, stretchable CNT percolation, and platinum-silicone composite, which are ideal for large-strain bioelectric applications to sense or modulate dynamic organ states.
Collapse
Affiliation(s)
- Dongxiao Yan
- Department of Electrical and Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Tim M. Bruns
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Yuting Wu
- Department of Electrical and Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Lauren L. Zimmerman
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Chris Stephan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
- Biointerfaces Institute, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Anne P. Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Euisik Yoon
- Department of Electrical and Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
- Center for Nanomedicine, Institute for Basic Science (IBS), Seoul, 03722, Korea
- Graduate Program of Nano Biomedical Engineering (Nano BME), Yonsei-IBS Institute, Yonsei University, Seoul, 03722, Korea
| | - John P. Seymour
- Department of Electrical and Engineering and Computer Science, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, USA
| |
Collapse
|
7
|
Bourbeau D, Aamoth K, Brose S, Gustafson K. Electrical Colon Stimulation Reflexively Increases Colonic Activity. Neuromodulation 2019; 23:1130-1136. [PMID: 31418508 DOI: 10.1111/ner.13035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/26/2019] [Accepted: 07/11/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Most individuals with spinal cord injury have neurogenic bowel dysfunction, which includes slowed colonic motility and has a significant impact on their health and quality of life. Bowel management typically includes mechanical rectal distension to evoke a recto-colic reflex and promote bowel emptying. Electrical stimulation could replace this mechanical distension. The purpose of this study was to determine the feasibility of evoking colonic activity using electrical stimulation. MATERIALS AND METHODS Acute experiments were conducted in eight neural-intact cats under chloralose anesthesia. Patterned electrical stimulation was administered via electrodes placed on the surface of the distal colon or proximal colon. Distal and proximal colon pressures were measured using saline-filled balloon catheters. Outcome measures included peak colonic pressure; time to onset of response; and time to peak pressure compared to baseline without stimulation. RESULTS Stimulation elicited colonic activity in all animals. Peak colon pressures were 15 ± 28 cmH2 O and were proportional to stimulation amplitudes. Time to onset and time to peak pressure were 13 ± 19 s and 37 ± 49 s, respectively, and were not significantly affected by stimulus parameters. Proximal colon stimulation only resulted in pressure responses from the proximal colon, but distal colon stimulation resulted in both proximal and distal responses in 40% of trials. Adding isoflurane anesthesia removed this proximal response to distal stimulation. CONCLUSIONS Distal colon stimulation evoked colonic activity. The dependence of this response on stimulation location and anesthesia suggests that responses were reflex mediated. Colonic stimulation may have the potential to improve colonic motility for individuals with neurogenic bowel dysfunction.
Collapse
Affiliation(s)
- Dennis Bourbeau
- Cleveland VA Medical Center, Cleveland, OH, USA.,MetroHealth Medical System, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA.,Cleveland FES Center, Cleveland, OH, USA
| | - Kelsey Aamoth
- Case Western Reserve University, Cleveland, OH, USA.,Cleveland FES Center, Cleveland, OH, USA
| | - Steven Brose
- Cleveland FES Center, Cleveland, OH, USA.,Syracuse VA Medical Center, Syracuse, NY, USA.,SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kenneth Gustafson
- Case Western Reserve University, Cleveland, OH, USA.,Cleveland FES Center, Cleveland, OH, USA
| |
Collapse
|
8
|
Cao N, Huang J, Ni J, Si J, Gu B, Wang Z, Andersson KE. Streptozotocin-induced diabetes causes upregulation of serotonin (5-HT)2A/C receptors in lumbosacral cord motoneurons and down regulation of serotonergic paraneurons in the urethra. Brain Res 2019; 1715:21-26. [DOI: 10.1016/j.brainres.2019.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 01/12/2023]
|
9
|
Time-Dependent Changes of Urethral Function in Diabetes Mellitus: A Review. Int Neurourol J 2019; 23:91-99. [PMID: 31260608 PMCID: PMC6606940 DOI: 10.5213/inj.1938050.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/04/2019] [Indexed: 12/12/2022] Open
Abstract
This article reviewed the current knowledge on time-course manifestation of diabetic urethral dysfunction (DUD), and explored an early intervention target to prevent the contribution of DUD to the progression of diabetes-induced impairment of the lower urinary tract (LUT). In the literature search through PubMed, key words used included “diabetes mellitus,” “diabetic urethral dysfunction,” and “diabetic urethropathy.” Polyuria and hyperglycemia induced by diabetes mellitus (DM) can cause the time-dependent changes in functional and morphological manifestations of DUD. In the early stage, it promotes urethral dysfunction characterized by increased urethral pressure during micturition. However, the detrusor muscle of the bladder tries to compensate for inducing complete voiding by increasing the duration and amplitude of bladder contractions. As the disease progresses, it can induce an impairment of coordinated micturition due to dyssynergic activity of external urethra sphincter, leading to detrusor-sphincter dyssynergia. The impairment of relaxation mechanisms of urethral smooth muscles (USMs) may additionally be attributable to decreased responsiveness to nitric oxide, as well as increased USM responsiveness to α1-adrenergic receptor stimulation. In the late stage, diabetic neuropathy may play an important role in inducing LUT dysfunction, showing that the decompensation of the bladder and urethra, which can cause the decrease of voiding efficiency and the reduced thickness of the urothelium and the atrophy of striated muscle bundles, possibly leading to the vicious cycle of the LUT dysfunction. Further studies to increase our understandings of the functional and molecular mechanisms of DUD are warranted to explore potential targets for therapeutic intervention of DM-induced LUT dysfunction.
Collapse
|
10
|
Modeling the interactions between stimulation and physiologically induced APs in a mammalian nerve fiber: dependence on frequency and fiber diameter. J Comput Neurosci 2018; 45:193-206. [PMID: 30443813 DOI: 10.1007/s10827-018-0703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
Electrical stimulation of nerve fibers is used as a therapeutic tool to treat neurophysiological disorders. Despite efforts to model the effects of stimulation, its underlying mechanisms remain unclear. Current mechanistic models quantify the effects that the electrical field produces near the fiber but do not capture interactions between action potentials (APs) initiated by stimulus and APs initiated by underlying physiological activity. In this study, we aim to quantify the effects of stimulation frequency and fiber diameter on AP interactions involving collisions and loss of excitability. We constructed a mechanistic model of a myelinated nerve fiber receiving two inputs: the underlying physiological activity at the terminal end of the fiber, and an external stimulus applied to the middle of the fiber. We define conduction reliability as the percentage of physiological APs that make it to the somatic end of the nerve fiber. At low input frequencies, conduction reliability is greater than 95% and decreases with increasing frequency due to an increase in AP interactions. Conduction reliability is less sensitive to fiber diameter and only decreases slightly with increasing fiber diameter. Finally, both the number and type of AP interactions significantly vary with both input frequencies and fiber diameter. Modeling the interactions between APs initiated by stimulus and APs initiated by underlying physiological activity in a nerve fiber opens opportunities towards understanding mechanisms of electrical stimulation therapies.
Collapse
|
11
|
Peh WYX, Raczkowska MN, Teh Y, Alam M, Thakor NV, Yen SC. Closed-loop stimulation of the pelvic nerve for optimal micturition. J Neural Eng 2018; 15:066009. [PMID: 30181427 DOI: 10.1088/1741-2552/aadee9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Neural stimulation to restore bladder function has traditionally relied on open-loop approaches that used pre-set parameters, which do not adapt to suboptimal outcomes. The goal of this study was to examine the effectiveness of a novel closed-loop stimulation paradigm for improving micturition or bladder voiding. APPROACH We compared the voiding efficiency obtained with this closed-loop framework against open-loop stimulation paradigms in anesthetized rats. The bladder pressures that preceded voiding, and the minimum current amplitudes for stimulating the pelvic nerves to evoke bladder contractions, were first calibrated for each animal. An automated closed-loop system was used to initiate voiding upon bladder fullness, adapt the stimulation current by using real-time bladder pressure changes to classify voiding outcomes, and halt stimulation when the bladder had been emptied or when the safe stimulation limit was reached. MAIN RESULTS In vivo testing demonstrated that the closed-loop system achieved high voiding efficiency or VE (75.7% ± 3.07%, mean ± standard error of the mean) and outperformed open-loop systems with either conserved number of stimulation epochs (63.2% ± 4.90% VE) or conserved charge injected (32.0% ± 1.70% VE). Post-hoc analyses suggest that the classification algorithm can be further improved with data from additional closed-loop experiments. SIGNIFICANCE This novel approach may be applied to an implantable device for treating underactive bladder (<60% VE), especially in cases where under- or over-stimulation of the nerve is a concern.
Collapse
Affiliation(s)
- Wendy Yen Xian Peh
- Singapore Institute for Neurotechnology, National University of Singapore, 28 Medical Drive, #05-02, Singapore 117456, Singapore
| | | | | | | | | | | |
Collapse
|
12
|
Grill WM. Temporal Pattern of Electrical Stimulation is a New Dimension of Therapeutic Innovation. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2018; 8:1-6. [PMID: 30906909 DOI: 10.1016/j.cobme.2018.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Artificial activation of the nervous system requires selection of appropriate stimulation parameters including stimulation amplitude, stimulation pulse duration, and stimulation pulse repetition rate. The temporal pattern of stimulation, i.e., the timing between stimulation pulses, is a novel dimension of stimulation parameter tuning. The effects evoked by artificial activation of the nervous system are dependent on the pattern of stimulation, and different patterns of stimulation, even when delivered at the same average rate, evoke different functional effects, different changes in synaptic plasticity, and even different patterns of gene expression. Non-regular temporal patterns of stimulation offer the opportunity to improve the efficacy and efficiency of therapeutic stimulation as well as to manipulate other processes in the nervous system. The potential design space for sequences of varying interpulse intervals is exceedingly large and sound approaches to design stimulation patterns are required as an empirical approach is not practical.
Collapse
Affiliation(s)
- Warren M Grill
- Departments of Biomedical Engineering, Electrical and Computer Engineering, Neurobiology, and Neurosurgery, Duke University, Durham NC
| |
Collapse
|
13
|
Rutter EM, Langdale CL, Hokanson JA, Hamilton F, Tran H, Grill WM, Flores KB. Detection of Bladder Contractions From the Activity of the External Urethral Sphincter in Rats Using Sparse Regression. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1636-1644. [PMID: 30004881 DOI: 10.1109/tnsre.2018.2854675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bladder overactivity and incontinence and dysfunction can be mitigated by electrical stimulation of the pudendal nerve applied at the onset of a bladder contraction. Thus, it is important to predict accurately both bladder pressure and the onset of bladder contractions. We propose a novel method for prediction of bladder pressure using a time-dependent spectrogram representation of external urethral sphincter electromyographic (EUS EMG) activity and a least absolute shrinkage and selection operator regression model. There was a statistically significant improvement in prediction of bladder pressure compared with methods based on the firing rate of EUS EMG activity. This approach enabled prediction of the onset of bladder contractions with 91% specificity and 96% sensitivity and may be suitable for closed-loop control of bladder continence.
Collapse
|
14
|
Coelho A, Oliveira R, Cavaleiro H, Cruz CD, Cruz F. Evidence for an urethro-vesical crosstalk mediated by serotonin. Neurourol Urodyn 2018; 37:2389-2397. [DOI: 10.1002/nau.23590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Ana Coelho
- Instituto de Investigação e Inovação em Saúde; Translational Neuro-urology Group, Universidade do Porto; Porto Portugal
- Instituto de Biologia Molecular e Celular; Universidade do Porto; Porto Portugal
- Faculdade de Medicina, Departmento de Biomedicina; Unidade de Biologia Experimental, Universidade do Porto; Porto Portugal
| | - Raquel Oliveira
- Instituto de Investigação e Inovação em Saúde; Translational Neuro-urology Group, Universidade do Porto; Porto Portugal
- Instituto de Biologia Molecular e Celular; Universidade do Porto; Porto Portugal
- Faculdade de Medicina, Departmento de Biomedicina; Unidade de Biologia Experimental, Universidade do Porto; Porto Portugal
| | - Helena Cavaleiro
- Faculdade de Medicina, Departmento de Biomedicina; Unidade de Biologia Experimental, Universidade do Porto; Porto Portugal
| | - Celia Duarte Cruz
- Instituto de Investigação e Inovação em Saúde; Translational Neuro-urology Group, Universidade do Porto; Porto Portugal
- Instituto de Biologia Molecular e Celular; Universidade do Porto; Porto Portugal
- Faculdade de Medicina, Departmento de Biomedicina; Unidade de Biologia Experimental, Universidade do Porto; Porto Portugal
| | - Francisco Cruz
- Instituto de Investigação e Inovação em Saúde; Translational Neuro-urology Group, Universidade do Porto; Porto Portugal
- Instituto de Biologia Molecular e Celular; Universidade do Porto; Porto Portugal
- Hospital de S. João; Departamento de Urologia; Porto Portugal
| |
Collapse
|
15
|
Li S, Li X, Theisen K, Browning J, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Saphenous nerve stimulation normalizes bladder underactivity induced by tibial nerve stimulation in cats. Am J Physiol Renal Physiol 2017; 315:F247-F253. [PMID: 29070575 DOI: 10.1152/ajprenal.00422.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study in α-chloralose-anesthetized cats aimed at investigating the bladder responses to saphenous nerve stimulation (SNS). A urethral catheter was used to infuse the bladder with saline and to record changes in bladder pressure. With the bladder fully distended, SNS at 1-Hz frequency and an intensity slightly below the threshold (T) for inducing an observable motor response of the hindlimb muscles induced large amplitude (40-150 cmH2O) bladder contractions. Application of SNS (1 Hz, 2-4T) during cystometrograms (CMGs), when the bladder was slowly (1-3 ml/min) infused with saline, significantly ( P < 0.05) increased the duration of the micturition contraction to >200% of the control without changing bladder capacity or contraction amplitude. Repeated application (1-8 times) of intense (4-8T intensity) 30-min tibial nerve stimulation (TNS) produced prolonged post-TNS inhibition that significantly ( P < 0.01) increased bladder capacity to 135.9 ± 7.6% and decreased the contraction amplitude to 44.1 ± 16.5% of the pre-TNS control level. During the period of post-TNS inhibition, SNS (1 Hz, 2-4T) applied during CMGs completely restored the bladder capacity and the contraction amplitude to the pre-TNS control level and almost doubled the duration of the micturition contraction. These results indicate that SNS at 1 Hz can facilitate the normal micturition reflex and normalize the reflex when it is suppressed during post-TNS inhibition. This study provides an opportunity to develop a novel neuromodulation therapy for underactive bladder using SNS.
Collapse
Affiliation(s)
- Shun Li
- Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania.,Department of Urology, Qianfoshan Hospital, Shandong University , Jinan , People's Republic of China
| | - Xing Li
- Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania.,Department of Urology, China Rehabilitation Research Center, School of Rehabilitation Medicine, Capital Medical University , Beijing , People's Republic of China
| | - Katherine Theisen
- Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jeffery Browning
- Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Bing Shen
- Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - James R Roppolo
- Department of Pharmacology and Chemical Biology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh , Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh , Pittsburgh, Pennsylvania.,Department of Bioengineering, University of Pittsburgh , Pittsburgh, Pennsylvania
| |
Collapse
|
16
|
Su X, Simenson HA, Paralikar K, Orser HD. Comparison of Bladder Inhibitory Effects of Patterned Spinal Nerve Stimulation With Conventional Neuromodulation in the Rat. Neuromodulation 2017; 20:787-792. [PMID: 28782237 DOI: 10.1111/ner.12640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The present study compared the effectiveness of patterned frequency of spinal nerve stimulation (SNS) with continuous, fixed-frequency nerve stimulation in an animal model of the bladder reflex contraction (BRC). MATERIALS AND METHODS In anesthetized female rats, wire electrodes were placed under each of the L6 spinal nerve to produce bilateral SNS. A cannula was placed into the bladder via the urethra, and the urethra was ligated to ensure an isovolumetric bladder. RESULTS Using motor threshold intensity, continuous stimulation at fixed frequencies of 4 Hz (n = 5) and 10 Hz (n = 7) decreased the frequency of BRC of 71 ± 24% (mean, SEM) and 85 ± 18% of controls, respectively (vs. no stimulation, n = 10, p < 0.05, two-way analysis of variance [ANOVA]). Fixed-frequency stimulation at 0.01, 0.1, 1, 40, and 100 Hz, did not demonstrate a trend change on BRC. When stimulation frequency is delivered with a 4-6 pulse/burst pattern every 1-100 sec, neuromodulation has demonstrated a trend toward effectiveness, with a four-pulse 40 Hz burst stimulation per second showing the most difference, reducing the BRC frequency of 74 ± 8% of control (n = 8, p < 0.05, two-way ANOVA). However, it is not more effective than continuous neuromodulation at a fixed frequency of 4 Hz or 10 Hz at BRC inhibition. CONCLUSIONS Burst stimulations may inhibit bladder contractions; however, they are not more effective than continuous neuromodulation. Without further knowledge regarding mechanisms and potential benefit of burst stimulation on bladder control in patients with neuropathological conditions, applications should utilize continuous fixed 10 Hz stimulation for maximal clinical outcomes.
Collapse
Affiliation(s)
- Xin Su
- Medtronic, Inc., Restorative Therapies Group, Research & Core Technology, Minneapolis, MN, USA
| | - Heather A Simenson
- Medtronic, Inc., Physiological Research Laboratories, Minneapolis, MN, USA
| | - Kunal Paralikar
- Medtronic, Inc., Restorative Therapies Group, Research & Core Technology, Minneapolis, MN, USA
| | - Heather D Orser
- Medtronic, Inc., Restorative Therapies Group, Research & Core Technology, Minneapolis, MN, USA
| |
Collapse
|
17
|
Khurram A, Ross SE, Sperry ZJ, Ouyang A, Stephan C, Jiman AA, Bruns TM. Chronic monitoring of lower urinary tract activity via a sacral dorsal root ganglia interface. J Neural Eng 2017; 14:036027. [PMID: 28322213 DOI: 10.1088/1741-2552/aa6801] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Our goal is to develop an interface that integrates chronic monitoring of lower urinary tract (LUT) activity with stimulation of peripheral pathways. APPROACH Penetrating microelectrodes were implanted in sacral dorsal root ganglia (DRG) of adult male felines. Peripheral electrodes were placed on or in the pudendal nerve, bladder neck and near the external urethral sphincter. Supra-pubic bladder catheters were implanted for saline infusion and pressure monitoring. Electrode and catheter leads were enclosed in an external housing on the back. Neural signals from microelectrodes and bladder pressure of sedated or awake-behaving felines were recorded under various test conditions in weekly sessions. Electrodes were also stimulated to drive activity. MAIN RESULTS LUT single- and multi-unit activity was recorded for 4-11 weeks in four felines. As many as 18 unique bladder pressure single-units were identified in each experiment. Some channels consistently recorded bladder afferent activity for up to 41 d, and we tracked individual single-units for up to 23 d continuously. Distension-evoked and stimulation-driven (DRG and pudendal) bladder emptying was observed, during which LUT sensory activity was recorded. SIGNIFICANCE This chronic implant animal model allows for behavioral studies of LUT neurophysiology and will allow for continued development of a closed-loop neuroprosthesis for bladder control.
Collapse
Affiliation(s)
- Abeer Khurram
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, United States of America. Biointerfaces Institute, University of Michigan, Ann Arbor, MI, United States of America
| | | | | | | | | | | | | |
Collapse
|
18
|
Emerging neural stimulation technologies for bladder dysfunctions. Int Neurourol J 2015; 19:3-11. [PMID: 25833475 PMCID: PMC4386488 DOI: 10.5213/inj.2015.19.1.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 01/16/2023] Open
Abstract
In the neural engineering field, physiological dysfunctions are approached by identifying the target nerves and providing artificial stimulation to restore the function. Neural stimulation and recording technologies play a central role in this approach, and various engineering devices and stimulation techniques have become available to the medical community. For bladder control problems, electrical stimulation has been used as one of the treatments, while only a few emerging neurotechnologies have been used to tackle these problems. In this review, we introduce some recent developments in neural stimulation technologies including microelectrode array, closed-loop neural stimulation, optical stimulation, and ultrasound stimulation.
Collapse
|
19
|
McGee MJ, Amundsen CL, Grill WM. Electrical stimulation for the treatment of lower urinary tract dysfunction after spinal cord injury. J Spinal Cord Med 2015; 38:135-46. [PMID: 25582564 PMCID: PMC4397195 DOI: 10.1179/2045772314y.0000000299] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Electrical stimulation for bladder control is an alternative to traditional methods of treating neurogenic lower urinary tract dysfunction (NLUTD) resulting from spinal cord injury (SCI). In this review, we systematically discuss the neurophysiology of bladder dysfunction following SCI and the applications of electrical stimulation for bladder control following SCI, spanning from historic clinical approaches to recent pre-clinical studies that offer promising new strategies that may improve the feasibility and success of electrical stimulation therapy in patients with SCI. Electrical stimulation provides a unique opportunity to control bladder function by exploiting neural control mechanisms. Our understanding of the applications and limitations of electrical stimulation for bladder control has improved due to many pre-clinical studies performed in animals and translational clinical studies. Techniques that have emerged as possible opportunities to control bladder function include pudendal nerve stimulation and novel methods of stimulation, such as high frequency nerve block. Further development of novel applications of electrical stimulation will drive progress towards effective therapy for SCI. The optimal solution for restoration of bladder control may encompass a combination of efficient, targeted electrical stimulation, possibly at multiple locations, and pharmacological treatment to enhance symptom control.
Collapse
Affiliation(s)
- Meredith J. McGee
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - Warren M. Grill
- Correspondence to: Warren M. Grill, Department of Biomedical Engineering, Duke University, 136 Hudson Hall, Box 90281, Durham, NC 27708-0281 USA.
| |
Collapse
|
20
|
Crago PE, Makowski NS. Alteration of neural action potential patterns by axonal stimulation: the importance of stimulus location. J Neural Eng 2014; 11:056016. [PMID: 25161163 DOI: 10.1088/1741-2560/11/5/056016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Stimulation of peripheral nerves is often superimposed on ongoing motor and sensory activity in the same axons, without a quantitative model of the net action potential train at the axon endpoint. APPROACH We develop a model of action potential patterns elicited by superimposing constant frequency axonal stimulation on the action potentials arriving from a physiologically activated neural source. The model includes interactions due to collision block, resetting of the neural impulse generator, and the refractory period of the axon at the point of stimulation. MAIN RESULTS Both the mean endpoint firing rate and the probability distribution of the action potential firing periods depend strongly on the relative firing rates of the two sources and the intersite conduction time between them. When the stimulus rate exceeds the neural rate, neural action potentials do not reach the endpoint and the rate of endpoint action potentials is the same as the stimulus rate, regardless of the intersite conduction time. However, when the stimulus rate is less than the neural rate, and the intersite conduction time is short, the two rates partially sum. Increases in stimulus rate produce non-monotonic increases in endpoint rate and continuously increasing block of neurally generated action potentials. Rate summation is reduced and more neural action potentials are blocked as the intersite conduction time increases. At long intersite conduction times, the endpoint rate simplifies to being the maximum of either the neural or the stimulus rate. SIGNIFICANCE This study highlights the potential of increasing the endpoint action potential rate and preserving neural information transmission by low rate stimulation with short intersite conduction times. Intersite conduction times can be decreased with proximal stimulation sites for muscles and distal stimulation sites for sensory endings. The model provides a basis for optimizing experiments and designing neuroprosthetic interventions involving motor or sensory stimulation.
Collapse
Affiliation(s)
- Patrick E Crago
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA. Cleveland Functional Electrical Stimulation (FES) Center, Cleveland, OH 44106 USA
| | | |
Collapse
|
21
|
Bruns TM, Weber DJ, Gaunt RA. Microstimulation of afferents in the sacral dorsal root ganglia can evoke reflex bladder activity. Neurourol Urodyn 2014; 34:65-71. [PMID: 24464833 DOI: 10.1002/nau.22514] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/19/2013] [Indexed: 11/07/2022]
Abstract
AIMS Pudendal afferent fibers can be excited using electrical stimulation to evoke reflex bladder activity. While this approach shows promise for restoring bladder function, stimulation of desired pathways, and integration of afferent signals for sensory feedback remains challenging. At sacral dorsal root ganglia (DRG), the convergence of pelvic and pudendal afferent fibers provides a unique location for access to lower urinary tract neurons. Our goal in this study was to demonstrate the potential of microstimulation in sacral DRG for evoking reflex bladder responses. METHODS Penetrating microelectrode arrays were inserted in the left S1 and S2 DRG of six anesthetized adult male cats. While the bladder volume was held at a level below the leak volume, single and multiple channel stimulation was performed using various stimulation patterns. RESULTS Reflex bladder excitation was observed in five cats, for stimulation in either S1 or S2 DRG at 1 Hz and 30-33 Hz with a pulse amplitude of 10-50 µA. Bladder relaxation was observed during a few trials. Adjacent electrodes frequently elicited very different responses. CONCLUSIONS These results demonstrate the potential of low-current microstimulation to recruit reflexive bladder responses. An approach such as this could be integrated with DRG recordings of bladder afferents to provide a closed-loop bladder neuroprosthesis.
Collapse
Affiliation(s)
- Tim M Bruns
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennysylvania
| | | | | |
Collapse
|
22
|
Sanders PM, IJzerman MJ, Roach MJ, Gustafson KJ. Patient preferences for next generation neural prostheses to restore bladder function. Spinal Cord 2011; 49:113-9. [PMID: 20531360 PMCID: PMC4987090 DOI: 10.1038/sc.2010.65] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A survey administered to 66 individuals with spinal cord injury (SCI) implementing a choice-based conjoint (CBC) analysis. Six attributes with three levels each were defined and used to generate choice sets with treatment scenarios. Patients were asked to choose the scenario that they preferred most. OBJECTIVES To determine the utility weights for treatment characteristics as well as the overall preference for the three types of neural prostheses (NP), that is Brindley, rhizotomy-free Brindley, and pudendal nerve stimulation. Earlier studies have revealed the importance of restoration of bladder function, but no studies have been performed to determine the importance of NP features. SETTING Two academic affiliated medical systems' SCI outpatient and inpatient rehabilitation programs, Cleveland, OH. METHODS CBC analysis followed by multinomial logit modeling. Individual part-worth utilities were estimated using hierarchical Bayes. RESULTS Side effects had the greatest significant impact on subject choices, followed by the effectiveness on continence and voiding. NPs with rhizotomy-free sacral root stimulation were preferred (45% first choice) over pudendal afferent nerve stimulation (39% second choice) and sacral root stimulation with rhizotomy (53% third choice). Almost 20% did not want to have an NP at all times. CONCLUSION CBC has shown to be a valuable tool to support design choices. The data showed that persons would prefer a bladder NP with minimally invasive electrodes, which would give them complete bladder function, with no side effects and that can be operated by pushing a button and they do not have to recharge themselves.
Collapse
Affiliation(s)
- Patricia M.H. Sanders
- Department for Health Technology and Services Research. University of Twente, Enschede, NL
- Case Western Reserve University, Cleveland, OH, USA
| | - Maarten J. IJzerman
- Department for Health Technology and Services Research. University of Twente, Enschede, NL
- Case Western Reserve University, Cleveland, OH, USA
| | - Mary Joan Roach
- Case Western Reserve University, Cleveland, OH, USA
- MetroHealth Medical System, Department of PM&R and the Center for Health Research and Policy, Cleveland, OH, USA
| | - Kenneth J. Gustafson
- Case Western Reserve University, Cleveland, OH, USA
- Louis Stokes Cleveland VA Medical Center and the APT Center, Cleveland, OH, USA
- Cleveland FES Center Cleveland, OH, USA
| |
Collapse
|
23
|
Pudendal Nerve Neuromodulation: A New Option for Refractory Bladder Overactivity and Pain. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0052-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|