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Sahu S, Venkataraman S, Chanu AR, Singh U. Transcutaneous neuromodulation versus oxybutynin for neurogenic detrusor overactivity in persons with spinal cord injury: A randomized, investigator blinded, parallel group, non-inferiority controlled trial. J Spinal Cord Med 2024:1-8. [PMID: 38958641 DOI: 10.1080/10790268.2024.2370099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
STUDY DESIGN This study is a randomized, investigator-blinded, controlled trial with a non-inferiority design. OBJECTIVE To investigate the effectiveness of neuromodulation by transcutaneous electrical stimulation of the somatic afferent nerves of the foot in neurogenic detrusor overactivity (NDO) in persons with spinal cord injury (SCI) and compare its effectiveness with oral oxybutynin. SETTING The study was conducted in a rehabilitation in-patient ward of a tertiary care hospital. METHODS Twenty-nine persons with SCI with NDO, either sex, aged 18 years and above were randomized into two groups, one group receiving oral oxybutynin (5 mg thrice a day for two weeks) and the other transcutaneous electrical stimulation (5 Hz, 200 µs pulse, biphasic, amplitude up to 60 mA, 30 min/day for two weeks). Bladder capacity was evaluated by clinical bladder evaluation (i.e. bladder capacity measured by adding leak volume, voiding volume if any, and post-void residue using a catheter) and cystometric bladder capacity by one-channel cystometry. Maximum cystometric pressure was evaluated by one-channel water cystometry. Data were analyzed with Fisher's Exact, t-test, and Wilcoxon rank sum tests. RESULTS Bladder capacity improved significantly in the oxybutynin and neuromodulation groups as measured by one-channel water cystometry (136 ml vs. 120.57 ml) and clinical evaluation (138.93 ml vs. 112 ml). The increase in the neuromodulation group achieved the pre-decided non-inferiority margin of 30 ml over the oxybutynin group when measured by one-channel water cystometry but not by clinical evaluation. Maximum cystometric pressure did not significantly improve in either group when compared with the baseline. CONCLUSION Transcutaneous neuromodulation and oxybutynin effectively increased bladder capacity in persons with SCI with NDO. Neuromodulation by once-a-day transcutaneous electrical stimulation was non-inferior to thrice-a-day oxybutynin when evaluated by one-channel water cystometry.Trial registration: Clinical Trials Registry India identifier: CTRI/2018/05/013735.
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Affiliation(s)
- Samantak Sahu
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Asem Rangita Chanu
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - U Singh
- Department of Physical Medicine and Rehabilitation, Mahatma Gandhi Medical College and Hospitals, Jaipur, Rajasthan, India
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2
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Stenqvist J, Tobin G. Adrenergic relaxations in an in situ urinary bladder model evoked by stimulation of sensory pelvic and pudendal nerves in the rat. Auton Neurosci 2024; 254:103194. [PMID: 38875740 DOI: 10.1016/j.autneu.2024.103194] [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: 01/31/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
Urinary bladder dysfunction might be related to disturbances at different levels of the micturition reflex arc. The current study aimed to further develop and evaluate a split bladder model for detecting and analysing relaxatory signalling in the rat urinary bladder. The model allows for discrimination between effects at the efferent and the afferent side of the innervation. In in vivo experiments, the stimulation at a low frequency (1 Hz) of the ipsilateral pelvic nerve tended to evoke relaxation of the split bladder half (contralateral side; -1.0 ± 0.4 mN; n = 5), in contrast to high frequency-evoked contractions. In preparations in which the contralateral pelvic nerve was cut the relaxation occurred at a wider range of frequencies (0.5-2 Hz). In separate experiments, responses to 1 and 2 Hz were studied before and after intravenous injections of propranolol (1 mg/kg IV). The presence of propranolol significantly shifted the relaxations into contractions. Also, electrical stimulation of the ipsilateral pudendal nerve evoked relaxations of similar magnitude as for the pelvic stimulations, which were also affected by propranolol. In control in vitro experiments, substances with β-adrenoceptor agonism, in contrast to a selective α-agonist, evoked relaxations. The current study shows that the split bladder model can be used for in vivo studies of relaxations. In the model, reflex-evoked sympathetic responses caused relaxations at low intensity stimulation. The involvement of β-adrenoceptors is supported by the sensitivity to propranolol and by the in vitro observations.
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Affiliation(s)
- Johanna Stenqvist
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Box 431, 405 30 Gothenburg, Sweden
| | - Gunnar Tobin
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Box 431, 405 30 Gothenburg, Sweden.
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3
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Qasemi A, Aminian A, Erfanian A. Real-time prediction of bladder urine leakage using fuzzy inference system and dual Kalman filtering in cats. Sci Rep 2024; 14:3879. [PMID: 38365925 PMCID: PMC10873426 DOI: 10.1038/s41598-024-53629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/02/2024] [Indexed: 02/18/2024] Open
Abstract
The use of electrical stimulation devices to manage bladder incontinence relies on the application of continuous inhibitory stimulation. However, continuous stimulation can result in tissue fatigue and increased delivered charge. Here, we employ a real-time algorithm to provide a short-time prediction of urine leakage using the high-resolution power spectrum of the bladder pressure during the presence of non-voiding contractions (NVC) in normal and overactive bladder (OAB) cats. The proposed method is threshold-free and does not require pre-training. The analysis revealed that there is a significant difference between voiding contraction (VC) and NVC pressures as well as band powers (0.5-5 Hz) during both normal and OAB conditions. Also, most of the first leakage points occurred after the maximum VC pressure, while all of them were observed subsequent to the maximum VC spectral power. Kalman-Fuzzy method predicted urine leakage on average 2.2 s and 1.6 s before its occurrence and an average of 2.0 s and 1.1 s after the contraction started with success rates of 94.2% and 100% in normal and OAB cats, respectively. This work presents a promising approach for developing a neuroprosthesis device, with on-demand stimulation to control bladder incontinence.
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Affiliation(s)
- Amirhossein Qasemi
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran
| | - Alireza Aminian
- 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.
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4
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Hokanson JA, Langdale CL, Grill WM. Pathways and parameters of sacral neuromodulation in rats. Am J Physiol Renal Physiol 2023; 325:F757-F769. [PMID: 37795537 PMCID: PMC10874681 DOI: 10.1152/ajprenal.00123.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 10/06/2023] Open
Abstract
The stimulation paradigm for sacral neuromodulation has remained largely unchanged since its inception. We sought to determine, in rats, whether stimulation-induced increases in bladder capacity correlated with the proportion of sensory pudendal (PudS) neurons at each stimulated location (L6, S1). If supported, this finding could guide the choice of stimulation side (left/right) and level (S2, S3, S4) in humans. Unexpectedly, we observed that acute stimulation at clinically relevant (low) amplitudes [1-1.5 × motor threshold (Tm)], did not increase bladder capacity, regardless of stimulus location (L6 or S1). More importantly for the ability to test our hypothesis, there was little anatomic variation, and S1 infrequently contributed nerve fibers to the PudS nerve. During mapping studies we noticed that large increases in PudS nerve activation occurred at amplitudes exceeding 2Tm. Thus, additional cystometric studies were conducted, this time with stimulation of the L6-S1 trunk, to examine further the relationship between stimulation amplitude and cystometric parameters. Stimulation at 1Tm to 6Tm evoked increases in bladder capacity and decreases in voiding efficiency that mirrored those produced by PudS nerve stimulation. Many animal studies involving electrical stimulation of nerves of the lower urinary tract use stimulation amplitudes that exceed those used clinically (∼1Tm). Our results confirm that high amplitudes generate immediate changes in cystometric parameters; however, the relationship to low-amplitude chronic stimulation in humans remains unclear. Additional studies are needed to understand changes that occur with chronic stimulation, how these changes relate to therapeutic outcomes, and the contribution of specific nerve fibers to these changes.NEW & NOTEWORTHY Acute low-amplitude electrical stimulation of sacral nerve (sacral neuromodulation) did not increase bladder capacity in anesthetized CD, obese-prone, or obese-resistant rats. Increasing stimulation amplitude correlated with increases in bladder capacity and pudendal sensory nerve recruitment. It is unclear how the high-amplitude acute stimulation that is commonly used in animal experiments to generate immediate effects compares mechanistically to the chronic low-amplitude stimulation used clinically.
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Affiliation(s)
- James A Hokanson
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Marquette University, Milwaukee, Wisconsin, United States
| | - Christopher L Langdale
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States
- Department of Neurobiology, Duke University, Durham, North Carolina, United States
- Department of Neurosurgery, Duke University, Durham, North Carolina, United States
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5
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Jaskowak DJ, Danziger ZC. Reflex voiding in rat occurs at consistent bladder volume regardless of pressure or infusion rate. Neurourol Urodyn 2023; 42:1532-1546. [PMID: 37583249 PMCID: PMC10461254 DOI: 10.1002/nau.25243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
AIMS The central nervous system (CNS) regulates lower urinary tract reflexes using information from sensory afferents; however, the mechanisms of this process are not well known. Pressure and volume were measured at the onset of the guarding and micturition reflexes across a range of infusion rates to provide insight into what the CNS is gauging to activate reflexes. METHODS Female Sprague Dawley rats were anesthetized with urethane for open outlet cystometry. A set of 10 infusion rates (ranging 0.92-65.5 mL/h) were pseudo-randomly distributed across 30 single-fill cystometrograms. Bladder pressure and external urethral sphincter electromyography were used for the determination of the onset of the micturition and guarding reflexes, respectively. The bladder volume at the onset of both reflexes was estimated from the total infusion rate during a single fill. RESULTS In response to many single-fill cystometrograms, there was an increased volume the bladder could store without a significant increase in pressure. Volume was adjusted for this effect for the analysis of how pressure and volume varied with infusion rate at the onset of the micturition and guarding reflexes. In 25 rats, the micturition reflex was evoked at similar volumes across all infusion rates, whereas the pressure at micturition reflex onset increased with increasing infusion rates. In 11 rats, the guarding reflex was evoked at similar pressures across infusion rates, but the volume decreased with increasing infusion rates. CONCLUSIONS These results suggest that the CNS is interpreting volume from the bladder to activate the micturition reflex and pressure from the bladder to activate the guarding reflex.
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Affiliation(s)
- Daniel J Jaskowak
- Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
| | - Zachary C Danziger
- Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
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6
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Aboumerhi K, Güemes A, Liu H, Tenore F, Etienne-Cummings R. Neuromorphic applications in medicine. J Neural Eng 2023; 20:041004. [PMID: 37531951 DOI: 10.1088/1741-2552/aceca3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023]
Abstract
In recent years, there has been a growing demand for miniaturization, low power consumption, quick treatments, and non-invasive clinical strategies in the healthcare industry. To meet these demands, healthcare professionals are seeking new technological paradigms that can improve diagnostic accuracy while ensuring patient compliance. Neuromorphic engineering, which uses neural models in hardware and software to replicate brain-like behaviors, can help usher in a new era of medicine by delivering low power, low latency, small footprint, and high bandwidth solutions. This paper provides an overview of recent neuromorphic advancements in medicine, including medical imaging and cancer diagnosis, processing of biosignals for diagnosis, and biomedical interfaces, such as motor, cognitive, and perception prostheses. For each section, we provide examples of how brain-inspired models can successfully compete with conventional artificial intelligence algorithms, demonstrating the potential of neuromorphic engineering to meet demands and improve patient outcomes. Lastly, we discuss current struggles in fitting neuromorphic hardware with non-neuromorphic technologies and propose potential solutions for future bottlenecks in hardware compatibility.
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Affiliation(s)
- Khaled Aboumerhi
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Amparo Güemes
- Electrical Engineering Division, Department of Engineering, University of Cambridge, 9 JJ Thomson Ave, Cambridge CB3 0FA, United Kingdom
| | - Hongtao Liu
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
| | - Francesco Tenore
- Research and Exploratory Development Department, The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, United States of America
| | - Ralph Etienne-Cummings
- Department of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD, United States of America
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7
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Shrikhande A, Patil S, Subhan M, Moody E, Natarajan J, Tailor Y, Mamsaang M, James N, Leishear K, Vyas R, Sandhu S, Ahmed T, Filart R, Daniel G, Kerin Orbuch I, Larish Y, Liu L. A Comprehensive Treatment Protocol for Endometriosis Patients Decreases Pain and Improves Function. Int J Womens Health 2023; 15:91-101. [PMID: 36713131 PMCID: PMC9882417 DOI: 10.2147/ijwh.s365637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/05/2022] [Indexed: 01/25/2023] Open
Abstract
Purpose The purpose of this paper is to evaluate the efficacy of a multimodal, outpatient neuromuscular protocol in treating remaining sensitization and myofascial pain in endometriosis patients post-surgical excision. Patients and Methods A retrospective longitudinal study was conducted for women aged 22 to 78 with a history of surgically excised endometriosis. 60 women with an average duration of pain of 8.63 ± 7.65 years underwent a treatment protocol consisting of ultrasound guided trigger point injections, peripheral nerve blocks, and pelvic floor physical therapy for 6 weeks. Concomitant cognitive behavioral therapy once weekly for a total of 12 weeks was also undertaken. Pain intensity and pelvic functionality were assessed at new patient consults and 3-month follow ups using Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS). Results At new patient consults, average VAS and FPPS were 7.45 ± 2.11 (CI 6.92-7.98) and 14.35 ± 6.62 (CI 12.68 -16.02), respectively. At 3-month follow ups, average VAS and FPPS decreased to 4.12 ± 2.44 (CI 3.50-4.73; p < 0.001) and 10.3 ± 6.55 (CI 8.64-11.96; p < 0.001), respectively. Among FPPS categories, sleeping, intercourse, and working showed the highest statistical significance. Conclusion Data suggests the multimodal protocol was effective in treating the remaining underlying sensitization and myofascial pain seen in Endometriosis patients post-surgical excision, particularly in decreasing pain and improving function during work and intercourse.
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Affiliation(s)
- Allyson Shrikhande
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA,Correspondence: Allyson Shrikhande, Email
| | - Soha Patil
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Merzia Subhan
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Erika Moody
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Janaki Natarajan
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Yogita Tailor
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Marjorie Mamsaang
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Neha James
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Kimberlee Leishear
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Rakhi Vyas
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Sandra Sandhu
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Tayyaba Ahmed
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Rosemarie Filart
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Gabrielle Daniel
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Iris Kerin Orbuch
- Providence St John’s Hospital, Santa Monica, CA, USA,Advanced Gynecologic Laparoscopy Center, Los Angeles, CA, USA
| | - Yaniv Larish
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Lora Liu
- Pelvic Rehabilitation Medicine Clinical Research Foundation, West Palm Beach, FL, USA,The Feinstein Institute for Medical Research, Manhasset, NY, USA
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8
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Hoey RF, Medina-Aguiñaga D, Khalifa F, Ugiliweneza B, Wang D, Zdunowski S, Fell J, Naglah A, El-Baz AS, Herrity AN, Harkema SJ, Hubscher CH. Thoracolumbar epidural stimulation effects on bladder and bowel function in uninjured and chronic transected anesthetized rats. Sci Rep 2022; 12:2137. [PMID: 35136100 PMCID: PMC8826941 DOI: 10.1038/s41598-022-06011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/18/2022] [Indexed: 11/09/2022] Open
Abstract
Pre-clinical studies have shown that spinal cord epidural stimulation (scES) at the level of pelvic and pudendal nerve inputs/outputs (L5-S1) alters storage and/or emptying functions of both the bladder and bowel. The current mapping experiments were conducted to investigate scES efficacy at the level of hypogastric nerve inputs/outputs (T13-L2) in male and female rats under urethane anesthesia. As found with L5-S1 scES, T13-L2 scES at select frequencies and intensities of stimulation produced an increase in inter-contraction interval (ICI) in non-injured female rats but a short-latency void in chronic T9 transected rats, as well as reduced rectal activity in all groups. However, the detrusor pressure during the lengthened ICI (i.e., urinary hold) remained at a low pressure and was not elevated as seen with L5-S1 scES, an effect that's critical for translation to the clinic as high fill pressures can damage the kidneys. Furthermore, T13-L2 scES was shown to stimulate voiding post-transection by increasing bladder activity while also directly inhibiting the external urethral sphincter, a pattern necessary to overcome detrusor-sphincter dyssynergia. Additionally, select scES parameters at T13-L2 also increased distal colon activity in all groups. Together, the current findings suggest that optimization of scES for bladder and bowel will likely require multiple electrode cohorts at different locations that target circuitries coordinating sympathetic, parasympathetic and somatic outputs.
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Affiliation(s)
- Robert F Hoey
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA.,Physical Medicine and Rehabilitation Department, MetroHealth Rehabilitation Institute of Ohio, Cleveland, OH, USA
| | - Daniel Medina-Aguiñaga
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Fahmi Khalifa
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Health Management and Systems Science, School of Public Health and Information Science, University of Louisville, Louisville, KY, USA
| | - Dengzhi Wang
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Sharon Zdunowski
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Jason Fell
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Ahmed Naglah
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - Ayman S El-Baz
- Bioengineering Department, University of Louisville J. B. Speed School of Engineering, Louisville, KY, USA
| | - April N Herrity
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Susan J Harkema
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA
| | - Charles H Hubscher
- Department of Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY, USA. .,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.
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9
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State-dependent bioelectronic interface to control bladder function. Sci Rep 2021; 11:314. [PMID: 33431964 PMCID: PMC7801663 DOI: 10.1038/s41598-020-79493-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Electrical stimulation therapies to promote bladder filling and prevent incontinence deliver continuous inhibitory stimulation, even during bladder emptying. However, continuous inhibitory stimulation that increases bladder capacity (BC) can reduce the efficiency of subsequent voiding (VE). Here we demonstrate that state-dependent stimulation, with different electrical stimulation parameters delivered during filling and emptying can increase both BC and VE relative to continuous stimulation in rats and cats of both sexes. We show that continuous 10 Hz pudendal nerve stimulation increased BC (120–180% of control) but decreased VE (12–71%, relative to control). In addition to increasing BC, state-dependent stimulation in both rats and cats increased VE (280–759% relative to continuous stimulation); motor bursting in cats increased VE beyond the control (no stimulation) condition (males: 323%; females: 161%). These results suggest that a bioelectronic bladder pacemaker can treat complex voiding disorders, including both incontinence and retention, which paradoxically are often present in the same individual.
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10
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Mohapatra A, Chen J, Zhao J, Zhong Y, Armann K, Shen B, Wang J, Beckel J, de Groat WC, Tai C. Bladder underactivity induced by prolonged pudendal afferent activity in cats. Am J Physiol Regul Integr Comp Physiol 2021; 320:R80-R87. [PMID: 33146553 PMCID: PMC7847056 DOI: 10.1152/ajpregu.00239.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to determine the effects of pudendal nerve stimulation (PNS) on reflex bladder activity and develop an animal model of underactive bladder (UAB). In six anesthetized cats, a bladder catheter was inserted via the urethra to infuse saline and measure pressure. A cuff electrode was implanted on the pudendal nerve. After determination of the threshold intensity (T) for PNS to induce an anal twitch, PNS (5 Hz, 0.2 ms, 2 T or 4 T) was applied during cystometrograms (CMGs). PNS (4-6 T) of 30-min duration was then applied repeatedly until bladder underactivity was produced. Following stimulation, control CMGs were performed over 1.5-2 h to determine the duration of bladder underactivity. When applied during CMGs, PNS (2 T and 4 T) significantly (P < 0.05) increased bladder capacity while PNS at 4 T also significantly (P < 0.05) reduced bladder contraction amplitude, duration, and area under contraction curve. Repeated application of 30-min PNS for a cumulative period of 3-8 h produced bladder underactivity exhibiting a significantly (P < 0.05) increased bladder capacity (173 ± 14% of control) and a significantly (P < 0.05) reduced contraction amplitude (50 ± 7% of control). The bladder underactivity lasted more than 1.5-2 h after termination of the prolonged PNS. These results provide basic science evidence supporting the proposal that abnormal afferent activity from external urethral/anal sphincter could produce central inhibition that underlies nonobstructive urinary retention (NOUR) in Fowler's syndrome. This cat model of UAB may be useful to investigate the mechanism by which sacral neuromodulation reverses NOUR in Fowler's syndrome.
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Affiliation(s)
- Anand Mohapatra
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jialiang Chen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jun Zhao
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Urology, The Second Affiliated Hospital of Xian Jiaotong University, Xian, China
| | - Yihua Zhong
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Kody Armann
- 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
| | - Jonathan Beckel
- 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
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11
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Designing and Implementing an Implantable Wireless Micromanometer System for Real-Time Bladder Pressure Monitoring: A Preliminary Study. SENSORS 2020; 20:s20164610. [PMID: 32824415 PMCID: PMC7472397 DOI: 10.3390/s20164610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/17/2022]
Abstract
Many mini-implantable devices have been developed and fabricated for diagnostic and treatment purposes. Wireless implantable biomicrosystems provide a desirable approach for long-term physiological signal monitoring. In this study, we implemented a wireless implantable biomicrosystem for bladder-cavity pressure measurements in a freely moving rabbit. To manage the power more effectively, a magnetic reed switch was applied to turn on/off the implantable module using a neodymium-iron-boron (NdFeB) magnet. The measured bladder pressure signal was wirelessly transmitted from the implantable module to a host unit. Our results indicated that the implantable biomicrosystem exhibited satisfactory performance and safety, as evidenced by an error percentage of less than ±1% for pressure measurements and less than 2 °C of a temperature rise under normal operation. The wireless biomicrosystem was implanted into the bladder cavity of a rabbit. Bladder pressure was simultaneously measured by both the biomicrosystem and conventional cystometry in the animal. The two signals were similar during the voiding phase, with a correlation coefficient of 0.885. Additionally, the biomicrosystem coated with polydimethylsiloxane in this study showed no cytotoxicity, which confirmed its biocompatibility. In conclusion, we demonstrated a good biocompatible wireless biomicrosystem which showed good reproducibility with respect to pressure monitoring by conventional cystometry. Further studies are needed to confirm the results of this preliminary feasibility study for actual clinical applications.
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Sysoev Y, Bazhenova E, Lyakhovetskii V, Kovalev G, Shkorbatova P, Islamova R, Pavlova N, Gorskii O, Merkulyeva N, Shkarupa D, Musienko P. Site-Specific Neuromodulation of Detrusor and External Urethral Sphincter by Epidural Spinal Cord Stimulation. Front Syst Neurosci 2020; 14:47. [PMID: 32774243 PMCID: PMC7387722 DOI: 10.3389/fnsys.2020.00047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
Impairments of the lower urinary tract function including urine storage and voiding are widely spread among patients with spinal cord injuries. The management of such patients includes bladder catheterization, surgical and pharmacological approaches, which reduce the morbidity from urinary tract-related complications. However, to date, there is no effective treatment of neurogenic bladder and restoration of urinary function. In the present study, we examined neuromodulation of detrusor (Detr) and external urethral sphincter by epidural electrical stimulation (EES) of lumbar and sacral regions of the spinal cord in chronic rats. To our knowledge, it is the first chronic study where detrusor and external urethral sphincter signals were recorded simultaneously to monitor their neuromodulation by site-specific spinal cord stimulation (SCS). The data obtained demonstrate that activation of detrusor muscle mainly occurs during the stimulation of the upper lumbar (L1) and lower lumbar (L5-L6) spinal segments whereas external urethral sphincter was activated predominantly by sacral stimulation. These findings can be used for the development of neurorehabilitation strategies based on spinal cord epidural stimulation for autonomic function recovery after severe spinal cord injury (SCI).
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Affiliation(s)
- Yuriy Sysoev
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Department of Pharmacology and Clinical Pharmacology, Saint-Petersburg State Chemical Pharmaceutical University, Saint-Petersburg, Russia
| | - Elena Bazhenova
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Vsevolod Lyakhovetskii
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Gleb Kovalev
- Clinic of High Medical Technology named after N.I. Pirogov St. Petersburg State University, Saint-Petersburg, Russia
| | - Polina Shkorbatova
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Regina Islamova
- Institute of Chemistry, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Natalia Pavlova
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Oleg Gorskii
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Natalia Merkulyeva
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Dmitry Shkarupa
- Clinic of High Medical Technology named after N.I. Pirogov St. Petersburg State University, Saint-Petersburg, Russia
| | - Pavel Musienko
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia.,Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
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Langdale CL, Hokanson JA, Milliken PH, Sridhar A, Grill WM. Stimulation of the pelvic nerve increases bladder capacity in the PGE 2 cat model of overactive bladder. Am J Physiol Renal Physiol 2020; 318:F1357-F1368. [PMID: 32308021 DOI: 10.1152/ajprenal.00068.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Selective electrical stimulation of the pudendal nerve exhibits promise as a potential therapy for treating overactive bladder (OAB) across species (rats, cats, and humans). More recently, pelvic nerve (PelN) stimulation was demonstrated to improve cystometric bladder capacity in a PGE2 rat model of OAB. However, PelN stimulation in humans or in an animal model that is more closely related to humans has not been explored. Therefore, our objective was to quantify the effects of PGE2 and PelN stimulation in the cat. Acute cystometry experiments were conducted in 14 α-chloralose-anesthetized adult, neurologically intact female cats. Intravesical PGE2 decreased bladder capacity, residual volume, threshold contraction pressure, and mean contraction pressure. PelN stimulation reversed the PGE2-induced decrease in bladder capacity and increased evoked external urethral sphincter electromyographic activity without influencing voiding efficiency. The increases in bladder capacity generated by PelN stimulation were similar in the rat and cat, but the stimulation parameters to achieve this effect differed (threshold amplitude at 10 Hz in the rat vs. twice threshold amplitude at 1 Hz in the cat). These results highlight the potential of PGE2 as a model of OAB and provide further evidence that PelN stimulation is a promising approach for the treatment of OAB symptoms.
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Affiliation(s)
| | - James A Hokanson
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | | | - Arun Sridhar
- Galvani Bioelectronics, Stevenage, United Kingdom
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina.,Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina.,Department of Neurobiology, Duke University, Durham, North Carolina.,Department of Neurosurgery Duke University, Durham, North Carolina
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Impact of transcutaneous interferential electrical stimulation for management of primary bladder neck dysfunction in children. J Pediatr Urol 2020; 16:36.e1-36.e6. [PMID: 31735518 DOI: 10.1016/j.jpurol.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Several studies have revealed that electrical stimulation is an effective modality for treatment of lower urinary tract (LUT) dysfunction via raising the capacity or compliance of the bladder or maybe by pelvic floor relaxation and reducing detrusor pressure as well. OBJECTIVE This study aimed to assess the efficacy of transcutaneous interferential (IF) electrical stimulation on LUT symptoms as well as urine flow parameters in children with primary bladder neck dysfunction (PBND). STUDY DESIGN We reviewed the charts of all children with persistent LUT symptoms who underwent IF electrical stimulation between 2010 and 2017. Twenty-three neurologically and anatomically normal children (mean age: 7.7 years, range: 5-13) with LUT symptoms were included in this study. Children had different LUT symptoms such as hesitancy, straining, urinary incontinence and constipation with no sufficient response to medical treatment (α -blocker) for at least 6 months. IF electrical stimulation was performed for 15 sessions, two times per week. All children were symptomatic and had abnormal urine flow pattern with an electromyographic (EMG) lag time of more than 6 s on uroflowmetry with EMG. A voiding chart, uroflowmetry with EMG and kidney and bladder ultrasounds were performed before and after the treatment for all children. Maximum and average urine flow rates, EMG lag time and postvoid residual volume were analyzed. In addition, alpha blocker therapy was continued during IF therapy. RESULTS Mean maximum and average urine flow rates improved from 14.1 to 7.6-19.7 ml/s and 9.5 ml/s, respectively, while mean EMG lag time decreased from 11.7 to 5.2 s after the treatment (all P < 0.05). Also postvoid residual volume decreased significantly from 35.6 to 7.6 ml at the end of treatment courses. DISCUSSION Pelvic floor EMG lag time, a documented parameter on uroflowmetry with EMG, defined as the time from the start of pelvic floor relaxation during a volitional voiding effort (the first stage of normal voiding) to the start of urine flow. Results showed that IF therapy decreased pelvic floor EMG lag time in children with PBND. In addition, increase in mean maximum and average urine flow rates in our patients indicated that pelvic IF therapy and behavioral modification improved voiding dysfunction in most of the patients and probably decreased bladder neck activity during voiding. Future studies with larger sample size are needed to support this finding. CONCLUSION IF therapy appears safe, effective and reproducible in improvement of PBND in children.
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Angoli D, Geramipour A, Danziger ZC. Validation of an efficient and continuous urodynamic monitoring system for awake, unrestrained, chronic rodent studies. Am J Physiol Renal Physiol 2019; 318:F86-F95. [PMID: 31736349 DOI: 10.1152/ajprenal.00349.2019] [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] [Indexed: 12/26/2022] Open
Abstract
The postvoid residual (PVR) is an important measure of bladder function, but obtaining PVR is burdensome because bladder volume must be measured at the time of voiding. The PVR measurement problem has led to experimental tricks in animal studies (infusing the bladder at supraphysiological rates and limiting animal observation windows) to keep the number of observed voids statistically robust while reducing the time an experimenter must be present. Our solution to the PVR measurement problem is a system called Automatic Monitoring for Efficient, Awake, Sensitive, Urine Residual Estimation (AMEASURE). AMEASURE combines metabolic cages and optimization algorithms to estimate continuously PVR for every voiding event 24 h/day for multiple weeks, without artificial bladder infusion, continuous experimenter supervision, anesthesia, or restraints. Using AMEASURE, we obtained voided volumes, PVRs, and other urodynamic parameters continuously for 21 days in 10 healthy female Sprague-Dawley rats. Importantly, this required only one manual measurement of animals' bladder volume every 12 h. We validated the accuracy of the system experimentally and in simulation. We detected marked differences in voiding frequency and efficiency between light and dark cycles and found that voiding frequency increased over time during the dark cycle (but not the light cycle), due to surgical recovery, cage acclimation, and socialization. This tool enhances the relevance of rodent models to the study of human lower urinary tract by expanding observation periods and obviating the need to infuse the bladder and facilitates the study of conditions for which behavioral, social, or circadian factors play essential roles.
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Affiliation(s)
- D Angoli
- Department of Biomedical Engineering, Florida International University, Miami, Florida
| | - A Geramipour
- Department of Biomedical Engineering, Florida International University, Miami, Florida
| | - Z C Danziger
- Department of Biomedical Engineering, Florida International University, Miami, Florida
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Potts BA, Degoski DJ, Brooks JM, Peterson AC, Nelson DE, Brink TS, Fraser MO. Timing of sacral neurostimulation is important for increasing bladder capacity in the anesthetized rat. Am J Physiol Renal Physiol 2019; 317:F1183-F1188. [PMID: 31411072 DOI: 10.1152/ajprenal.00167.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We assessed the effects of limited application of sacral neurostimulation (SNS) during bladder filling on bladder capacity using our previously published SNS model in rats. Female Sprague-Dawley rats (n = 24) were urethane anesthetized (1.2 g/kg sc) and implanted with jugular venous and transvesical bladder catheters. L6/S1 nerve trunks were isolated bilaterally, and two electrodes were placed on each exposed nerve. True bladder capacity (TBC) was determined using stable single-fill cystometrograms. In the first series of experiments, SNS was applied at the onset of bladder filling for 25%, 50%, 75%, and 100% of the previous control filling cycle duration (n = 10). In the second series of experiments, SNS was applied during the first, second, third, and fourth 25% and the first and second 50% of the control fill. In the first series, a significant increase in TBC was observed only when SNS was applied for 75% or 100% of the control fill duration (30% and 35%, respectively, P < 0.05). In the second series, significant increases in TBC only occurred during the fourth 25% period and second 50% period (32% and 43%, respectively, P < 0.001). Results from the second series also revealed an increase in subsequent single-fill bladder capacities (TBC) only when SNS was applied during the second 50% of the prior fill cycle. These data indicate that the application of SNS during the final 50% of the bladder fill cycle is necessary and sufficient for increasing bladder capacity.
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Affiliation(s)
- Bradley A Potts
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | | | - Andrew C Peterson
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Dwight E Nelson
- Research and Core Technology, Restorative Therapies Group, Medtronic Incorporated, Minneapolis, Minnesota
| | - Thaddeus S Brink
- Research and Core Technology, Restorative Therapies Group, Medtronic Incorporated, Minneapolis, Minnesota
| | - Matthew O Fraser
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Institute for Medical Research, Durham, North Carolina.,Research and Development Department, Durham Veterans Affairs Medical Center, Durham, North Carolina
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Coolen RL, Groen J, Blok B. Electrical stimulation in the treatment of bladder dysfunction: technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:337-345. [PMID: 31572023 PMCID: PMC6750158 DOI: 10.2147/mder.s179898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/24/2019] [Indexed: 01/24/2023] Open
Abstract
The urinary bladder has two functions: urine storage and voiding. Clinically, two major categories of lower urinary tract symptoms can be defined: storage symptoms such as incontinence and urgency, and voiding symptoms such as feeling of incomplete bladder emptying and slow urinary stream. Urgency to void with or without incontinence is called overactive bladder (OAB). Slow urinary stream, hesitancy, and straining to void with the feeling of incomplete bladder emptying are often called underactive bladder (UAB). The underlying causes of OAB or UAB can be either non-neurogenic (also referred to as idiopathic) and neurogenic, for example due to spinal cord injury or multiple sclerosis. OAB and UAB can be treated conservatively by lifestyle intervention or medication. In the case that conservative treatment does not provide sufficient benefit, electrical stimulation can be used. Sacral neurostimulation or neuromodulation (SNM) is offered as a third-line therapy to patients with non-neurogenic OAB or UAB. In SNM, the third or fourth sacral nerve root is stimulated and after a test period, a neuromodulator is implanted in the buttock. Until recently only a non-rechargeable neuromodulator was approved for clinical use. However, nowadays, a rechargeable sacral neuromodulator is also on the market, with similar safety and effectiveness to the non-rechargeable SNM system. The rechargeable device was approved for full body 1.5T and 3T MRI in Europe in February 2019. Regarding neurogenic lower urinary tract dysfunction, electrical stimulation only seems to benefit a selected group of patients.
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Affiliation(s)
- R L Coolen
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
| | - J Groen
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
| | - Bfm Blok
- Department of Urology, Erasmus Medical Center, Rotterdam 3015 GD, The Netherlands
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Ness TJ, McNaught J, Clodfelder-Miller B, Nelson DE, Su X. Neuromodulatory effects of pudendal nerve stimulation on bladder hypersensitivity are present in opioid-pretreated rats. Reg Anesth Pain Med 2019; 44:rapm-2018-100353. [PMID: 31488554 DOI: 10.1136/rapm-2018-100353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/16/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Bilateral electrical pudendal nerve stimulation (bPNS) reduces bladder hypersensitivity in rat models and anecdotally reduces pain in humans with pelvic pain of urologic origin. Concomitant opioids are known to alter responses to neuromodulation in some systems. So prior to the development of a clinical trial for purposes of regulatory approval, the preclinical interaction between opioids and stimulation effectiveness was examined. METHODS Bladder hypersensitivity was produced by neonatal bladder inflammation in rat pups coupled with a second inflammatory insult as an adult. Morphine was administered acutely (1-4 mg/kg intraperitoneal) or chronically (5 mg/kg subcutaneously daily for 2 weeks prior to the terminal experiment). bPNS consisted of bilateral biphasic electrical stimulation of the mixed motor/sensory component of the pudendal nerves. Visceromotor responses (VMR; abdominal muscle contractile responses to urinary bladder distension (UBD)) were used as nociceptive endpoints. RESULTS Morphine produced a dose-dependent inhibition of VMRs to UBD that was naloxone reversible. bPNS resulted in statistically significant inhibition of VMRs to UBD in hypersensitive rats that had received acute or chronic subcutaneous morphine injections. CONCLUSIONS This study suggests that inhibitory effects of bPNS can still be evoked in subjects who are receiving opioid therapy, thus giving guidance to potential clinical trials seeking regulatory approval for the treatment of chronic bladder pain.
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Affiliation(s)
- Timothy John Ness
- Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamie McNaught
- Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Dwight E Nelson
- Global Neuromodulation Research, Medtronic, Inc, Minneapolis, Minnesota, USA
| | - Xin Su
- Global Neuromodulation Research, Medtronic, Inc, Minneapolis, Minnesota, USA
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Gonzalez EJ, Grill WM. Sensory pudendal nerve stimulation increases bladder capacity through sympathetic mechanisms in cyclophosphamide-induced cystitis rats. Neurourol Urodyn 2018; 38:135-143. [PMID: 30350879 DOI: 10.1002/nau.23860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/21/2018] [Indexed: 01/06/2023]
Abstract
AIMS Interstitial cystitis and bladder pain syndrome is a prevalent health concern with inadequate treatments. Neuromodulation has emerged as a therapeutic option to treat patients refractory to standard care. The objective of this study was to determine the efficacy and mechanism(s) of sensory pudendal nerve stimulation on bladder function in cystitis rats. METHODS Female rats were administered saline (n = 8) or cyclophosphamide (CYP, 150 mg/kg IP, n = 16) and single-trial cystometry experiments were conducted under urethane anesthesia 48 h after injection. Electrical stimulation (0.02-0.22 mA, 10-20 Hz) was delivered to the sensory branch of the pudendal nerve and its effect on the bladder and external urethral sphincter were measured. Stimulation trials were also conducted following bilateral hypogastric nerve transection (HGNT) or pharmacological inhibition of beta-adrenergic receptors (propranolol, 1 mg/kg IV) to determine the mechanisms of bladder inhibition. RESULTS CYP-induced cystitis decreased bladder capacity (P = 0.0352) and bladder compliance (P = 0.024) by up to 38% of control. Electrical stimulation of the sensory pudendal nerve increased bladder capacity (P < 0.0001) in control and CYP rats by up to 51-52% of their respective baselines. HGNT did not influence bladder inhibition generated by sensory pudendal nerve stimulation in control rats, whereas HGNT and propranolol decreased the efficacy of electrical stimulation in CYP rats. CONCLUSIONS Sympathetic reflex activity mediates sensory pudendal nerve stimulation in CYP treated but not control rats. These studies demonstrate an alternative approach to neuromodulation in cystitis and establish mechanistic changes during stimulation that may enable the development of novel therapeutics.
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Affiliation(s)
- Eric J Gonzalez
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina.,Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina.,Department of Neurobiology, Duke University, Durham, North Carolina.,Department of Neurosurgery, Duke University, Durham, North Carolina
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Chai TC, Kudze T. New therapeutic directions to treat underactive bladder. Investig Clin Urol 2017; 58:S99-S106. [PMID: 29279882 PMCID: PMC5740036 DOI: 10.4111/icu.2017.58.s2.s99] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/18/2017] [Indexed: 11/18/2022] Open
Abstract
Underactive bladder (UAB) is a term used to describe a constellation of symptoms that is perceived by patients suggesting bladder hypocontractility. Urodynamic measurement that suggest decreased contractility of the bladder is termed detrusor underactivity (DUA). Regulatory approved specific management options with clinically proven ability to increase bladder contractility do not currently exist. While DUA specific treatments presumably will focus on methods to increase efficiency of bladder emptying capability relying on augmenting the motor pathway in the micturition reflex, other approaches include methods to augment the sensory (afferent) contribution to the micturition reflex which could result in increased detrusor contractility. Another method to induce more efficient bladder emptying could be to induce relaxation of the bladder outlet. Using cellular regenerative techniques, the detrusor smooth muscle can be targeted so the result is to increase detrusor smooth muscle function. In this review, we will cover areas of potential new therapies for DUA including: drug therapy, stem cells and regenerative therapies, neuromodulation, and urethral flow assist device. Paralleling development of new therapies, there also needs to be clinical studies performed that address how DUA relates to UAB.
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Affiliation(s)
- Toby C Chai
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
| | - Tambudzai Kudze
- Department of Urology, Yale University School of Medicine, New Haven, CT, USA
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