1
|
Gammie A, Wachter SD. Research priorities for diagnostic instrumentation in urinary incontinence. Proc Inst Mech Eng H 2024; 238:682-687. [PMID: 37667889 DOI: 10.1177/09544119231193884] [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] [Indexed: 09/06/2023]
Abstract
The International Consultation on Incontinence (ICI) captures current evidence on incontinence. The conference 'Incontinence: The Engineering Challenge XIII' in November 2021 heard an update on the most recent ICI summary on urodynamic testing. This paper summarises the ICI recommendations for future research in urodynamics, with a view to informing engineers of issues and challenges that could benefit from engineering solutions. Engineers are encouraged to contribute to the following areas of research, which will have a direct and positive effect on patients' quality of life and overall health: (a) Urine flow measurement: home- and app-based devices, machine learning analysis of flow shape, (b) Pressure measurement: normal values for and validation of new technologies, including air-filled, non-invasive and urethral pressure reflectometry, (c) Ultrasound imaging: bladder wall biomechanics, bladder shape analysis, (d) Assess normal and abnormal value ranges, and diagnostic performance and (e) Specific trials in understudied patient groups including those with symptoms resistant to treatment, children and the frail elderly.
Collapse
|
2
|
Zareen F, Elazab M, Hanzlicek B, Doelman A, Bourbeau D, Majerus SJ, Damaser MS, Karam R. Optimization of activity-driven event detection for long-term ambulatory urodynamics. Proc Inst Mech Eng H 2024; 238:608-618. [PMID: 39104258 DOI: 10.1177/09544119241264304] [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] [Indexed: 08/07/2024]
Abstract
Lower urinary tract dysfunction (LUTD) is a debilitating condition that affects millions of individuals worldwide, greatly diminishing their quality of life. The use of wireless, catheter-free implantable devices for long-term ambulatory bladder monitoring, combined with a single-sensor system capable of detecting various bladder events, has the potential to significantly enhance the diagnosis and treatment of LUTD. However, these systems produce large amounts of bladder data that may contain physiological noise in the pressure signals caused by motion artifacts and sudden movements, such as coughing or laughing, potentially leading to false positives during bladder event classification and inaccurate diagnosis/treatment. Integration of activity recognition (AR) can improve classification accuracy, provide context regarding patient activity, and detect motion artifacts by identifying contractions that may result from patient movement. This work investigates the utility of including data from inertial measurement units (IMUs) in the classification pipeline, and considers various digital signal processing (DSP) and machine learning (ML) techniques for optimization and activity classification. In a case study, we analyze simultaneous bladder pressure and IMU data collected from an ambulating female Yucatan minipig. We identified 10 important, yet relatively inexpensive to compute signal features, with which we achieve an average 91.5% activity classification accuracy. Moreover, when classified activities are included in the bladder event analysis pipeline, we observe an improvement in classification accuracy, from 81% to 89.0%. These results suggest that certain IMU features can improve bladder event classification accuracy with low computational overhead.Clinical Relevance: This work establishes that activity recognition may be used in conjunction with single-channel bladder event detection systems to distinguish between contractions and motion artifacts for reducing the incorrect classification of bladder events. This is relevant for emerging sensors that measure intravesical pressure alone or for data analysis of bladder pressure in ambulatory subjects that contain significant abdominal pressure artifacts.
Collapse
Affiliation(s)
- Farhath Zareen
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Mohammed Elazab
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brett Hanzlicek
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Adam Doelman
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
| | - Dennis Bourbeau
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, MetroHealth System, Cleveland, OH, USA
| | - Steve Ja Majerus
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Robert Karam
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| |
Collapse
|
3
|
Wright DN, Züchner M, Annavini E, Escalona MJ, Hammerlund Teige L, Whist Tvedt LG, Lervik A, Haga HA, Guiho T, Clausen I, Glott T, Boulland JL. From wires to waves, a novel sensor system for in vivo pressure monitoring. Sci Rep 2024; 14:7570. [PMID: 38555360 PMCID: PMC10981663 DOI: 10.1038/s41598-024-58019-5] [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: 09/30/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
Pressure monitoring in various organs of the body is essential for appropriate diagnostic and therapeutic purposes. In almost all situations, monitoring is performed in a hospital setting. Technological advances not only promise to improve clinical pressure monitoring systems, but also engage toward the development of fully implantable systems in ambulatory patients. Such systems would not only provide longitudinal time monitoring to healthcare personnel, but also to the patient who could adjust their way-of-life in response to the measurements. In the past years, we have developed a new type of piezoresistive pressure sensor system. Different bench tests have demonstrated that it delivers precise and reliable pressure measurements in real-time. The potential of this system was confirmed by a continuous recording in a patient that lasted for almost a day. In the present study, we further characterized the functionality of this sensor system by conducting in vivo implantation experiments in nine female farm pigs. To get a step closer to a fully implantable system, we also adapted two different wireless communication solutions to the sensor system. The communication protocols are based on MICS (Medical Implant Communication System) and BLE (Bluetooth Low Energy) communication. As a proof-of-concept, implantation experiments in nine female pigs demonstrated the functionality of both systems, with a notable technical superiority of the BLE.
Collapse
Affiliation(s)
| | - Mark Züchner
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0317, Oslo, Norway
| | - Eis Annavini
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0317, Oslo, Norway
| | - Manuel J Escalona
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0317, Oslo, Norway
- Department for Immunology, Clinic for Laboratory Medicine, Oslo University Hospital-Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Lena Hammerlund Teige
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0317, Oslo, Norway
- Department for Immunology, Clinic for Laboratory Medicine, Oslo University Hospital-Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Lars Geir Whist Tvedt
- Department of Microsystems and Nanotechnology, SINTEF AS, Oslo, Norway
- InVivo Bionics AS, Oslo, Norway
| | - Andreas Lervik
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Ås, Norway
| | - Henning A Haga
- Department of Companion Animal Clinical Sciences, Norwegian University of Life Sciences, Ås, Norway
| | | | - Ingelin Clausen
- Department of Microsystems and Nanotechnology, SINTEF AS, Oslo, Norway
- InVivo Bionics AS, Oslo, Norway
| | - Thomas Glott
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Jean-Luc Boulland
- Division of Physiology, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0317, Oslo, Norway.
- Department for Immunology, Clinic for Laboratory Medicine, Oslo University Hospital-Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.
| |
Collapse
|
4
|
Majerus SJA, Hanzlicek B, Hacohen Y, Cabal D, Bourbeau D, Damaser MS. Wireless and Catheter-Free Bladder Pressure and Volume Sensor. IEEE SENSORS JOURNAL 2024; 24:7308-7316. [PMID: 38500510 PMCID: PMC10947133 DOI: 10.1109/jsen.2023.3267749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Continuous monitoring of bladder activity during normal daily activities would improve clinical diagnostics and understanding of the mechanisms underlying bladder function, or help validate how differing neuromodulation strategies affect the bladder. This work describes a urological monitor of conscious activity (UroMOCA). The UroMOCA included a pressure sensor, urine impedance-sensing electrodes, and wireless battery recharge and data transmission circuitry. Components were assembled on a circuit board and encapsulated with an epoxy/silicone molded package that allowed Pt-Ir electrode feedthrough for urine contact. Packaged UroMOCAs measured 12 × 18 × 6 mm. UroMOCAs continuously transmitted data from all onboard sensors at 10 Hz at 30 cm range, and ran for up to 44 hours between wireless recharges. After in vitro calibration, implantations were performed in 11 animals. Animals carried the device for 28 days, enabling many observations of bladder behavior during natural, conscious behavior. In vivo testing confirmed the UroMOCA did not impact bladder function after a two-week healing period. Pressure data in vivo were highly correlated to a reference catheter used during an anesthetized follow-up. Static volume sensor data were less accurate, but demonstrated reliable detection of bladder volume decreases, and distinguished between voiding and non-voiding bladder events.
Collapse
Affiliation(s)
- Steve J A Majerus
- Dept. of Electrical, Computer, and Systems Engineering, Case Western Reserve University, OH, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Brett Hanzlicek
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Yaneev Hacohen
- Dept. of Electrical, Computer, and Systems Engineering, Case Western Reserve University, OH, USA
- Dept. of Biomedical Engineering of the Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dario Cabal
- Dept. of Electrical, Computer, and Systems Engineering, Case Western Reserve University, OH, USA
| | - Dennis Bourbeau
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
- MetroHealth Medical Center, Cleveland, OH, USA
| | - Margot S Damaser
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
- Dept. of Biomedical Engineering of the Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
5
|
Vogt B. Catheter-Free Urodynamics Testing: Current Insights and Clinical Potential. Res Rep Urol 2024; 16:1-17. [PMID: 38192632 PMCID: PMC10771720 DOI: 10.2147/rru.s387757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
Lower urinary tract dysfunction not only interferes with the health-related quality of life of patients but may also lead to acute kidney injury and infections. To assess the bladder, urodynamic studies (UDS) have been implemented but the use of catheters leads to discomfort for the patient. Catheter-free long-term UDS would be useful and a potential solution could be ambulatory wireless devices that communicate via telemetry. Such sensors can detect pressure or volume. Numerous types of potential catheter-free sensors have been proposed for bladder monitoring. Despite substantial innovation in the manufacturing of implantable biomedical electronic systems, such sensors have remained at the laboratory stage due to a number of critical challenges. These challenges primarily concern hermeticity and biocompatibility, sensitivity and artifacts, drift, telemetry, and energy management. Having overcome these challenges, catheter-free ambulatory urodynamic monitoring could combine a synchronized intravesical pressure sensor with a volume analyzer but only the steps of cystometry and volume measurement are currently sufficiently reproducible to simulate UDS results. The measurement of volume by infrared optical sensors, in the form of abdominal patches, appears to be promising and studies are underway to market a telemetric ambulatory urodynamic monitoring system that includes an intravesical pressure sensor. There has been considerable progress in wearable and conformable electronics on many fronts, and continued collaboration between engineers and urologists could quickly overcome current challenges. In addition, to the diagnosis of UDS, such sensors could be useful in the development of a long-term closed-loop neuromodulation system. In this review, we explore the various types of catheter-free bladder sensors, inherent challenges and solutions to overcome these challenges, and the clinical potential of such long-term implantable sensors.
Collapse
Affiliation(s)
- Benoît Vogt
- Department of Urology, Polyclinique de Blois, La Chaussée Saint-Victor, France
| |
Collapse
|
6
|
Kim H, Lee SH, Wentworth A, Babaee S, Wong K, Collins JE, Chu J, Ishida K, Kuosmanen J, Jenkins J, Hess K, Lopes A, Morimoto J, Wan Q, Potdar SV, McNally R, Tov C, Kim NY, Hayward A, Wollin D, Langer R, Traverso G. Biodegradable ring-shaped implantable device for intravesical therapy of bladder disorders. Biomaterials 2022; 288:121703. [PMID: 36030104 PMCID: PMC10485746 DOI: 10.1016/j.biomaterials.2022.121703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Intravesical instillation is an efficient drug delivery route for the local treatment of various urological conditions. Nevertheless, intravesical instillation is associated with several challenges, including pain, urological infection, and frequent clinic visits for catheterization; these difficulties support the need for a simple and easy intravesical drug delivery platform. Here, we propose a novel biodegradable intravesical device capable of long-term, local drug delivery without a retrieval procedure. The intravesical device is composed of drug encapsulating biodegradable polycaprolactone (PCL) microcapsules and connected by a bioabsorbable Polydioxanone (PDS) suture with NdFeB magnets in the end. The device is easily inserted into the bladder and forms a 'ring' shape optimized for maximal mechanical stability as informed by finite element analysis. In this study, inserted devices were retained in a swine model for 4 weeks. Using this device, we evaluated the system's capacity for delivery of lidocaine and resiquimod and demonstrated prolonged drug release. Moreover, a cost-effectiveness analysis supports device implementation compared to the standard of care. Our data support that this device can be a versatile drug delivery platform for urologic medications.
Collapse
Affiliation(s)
- Hyunjoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Seung Ho Lee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Adam Wentworth
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Sahab Babaee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Wong
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joy E Collins
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jacqueline Chu
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Keiko Ishida
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Johannes Kuosmanen
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Joshua Jenkins
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Hess
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Aaron Lopes
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joshua Morimoto
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Qianqian Wan
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Shaunak V Potdar
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ronan McNally
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Caitlynn Tov
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Na Yoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alison Hayward
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Daniel Wollin
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Robert Langer
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Giovanni Traverso
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
| |
Collapse
|
7
|
Holmes-Martin K, Zhu M, Xiao S, Arab Hassani F. Advances in Assistive Electronic Device Solutions for Urology. MICROMACHINES 2022; 13:mi13040551. [PMID: 35457855 PMCID: PMC9028141 DOI: 10.3390/mi13040551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022]
Abstract
Recent technology advances have led urology to become one of the leading specialities to utilise novel electronic systems to manage urological ailments. Contemporary bladder management strategies such as urinary catheters can provide a solution but leave the user mentally and physically debilitated. The unique properties of modern electronic devices, i.e., flexibility, stretchability, and biocompatibility, have allowed a plethora of new technologies to emerge. Many novel electronic device solutions in urology have been developed for treating impaired bladder disorders. These disorders include overactive bladder (OAB), underactive bladder (UAB) and other-urinary-affecting disorders (OUAD). This paper reviews common causes and conservative treatment strategies for OAB, UAB and OUAD, discussing the challenges and drawbacks of such treatments. Subsequently, this paper gives insight into clinically approved and research-based electronic advances in urology. Advances in this area cover bladder-stimulation and -monitoring devices, robot-assistive surgery, and bladder and sphincter prosthesis. This study aims to introduce the latest advances in electronic solutions for urology, comparing their advantages and disadvantages, and concluding with open problems for future urological device solutions.
Collapse
|
8
|
Liu Q, Wang R, Ma N, Wang C, Chen W. Telmisartan inhibits bladder smooth muscle fibrosis in neurogenic bladder rats. Exp Ther Med 2022; 23:216. [PMID: 35126719 PMCID: PMC8796288 DOI: 10.3892/etm.2022.11140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
Hypertension is associated with bladder symptoms. The present study investigated whether an angiotensin receptor blocker could improve the symptoms and pathological changes associated with a neurogenic bladder (NB). A Sprague-Dawley rat model of NB was constructed. Rats in the sham and model groups were gavaged with saline, and rats in the treatment group were gavaged with telmisartan. Urodynamic parameters, including maximum cystometric capacity, residual urine volume, bladder wet weight, bladder compliance and detrusor pressure, were detected. Masson and H&E staining were performed to assess bladder fibrosis and histopathological changes. The expression levels of basic fibroblast growth factor (bFGF), TGF-β1, Collagen I, Collagen III, and α-smooth muscle actin (α-SMA) were also measured by reverse transcription-quantitative PCR, western blotting and immunohistochemistry. The model rats exhibited symptoms and pathological changes associated with NB. Treatment with telmisartan reduced maximum cystometric capacity, residual urine volume, bladder compliance and bladder wet weight, and increased detrusor pressure in model rats. The tissue staining results showed that telmisartan exerted an antifibrotic effect. In addition, telmisartan inhibited the expression of bFGF, TGF-β1, Collagen I, Collagen III and α-SMA in model rats. Therefore, the results of the present study indicated that telmisartan may serve as a potential therapeutic agent for NB.
Collapse
Affiliation(s)
- Qian Liu
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Ruoyi Wang
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Nan Ma
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Chuntian Wang
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Weixiu Chen
- Department of Pediatric Surgery, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| |
Collapse
|
9
|
Keung MS, Streijger F, Herrity A, Ethridge J, Dougherty SM, Aslan S, Webster M, Fisk S, Deegan EG, Tessier-Cloutier B, Chen KYN, Morrison C, Okon EB, Tigchelaar S, Manouchehri N, Kim KT, Shortt K, So K, Damaser MS, Sherwood LC, Howland DR, Boakye M, Hubscher C, Stothers L, Kavanagh A, Kwon BK. Characterization of Lower Urinary Tract Dysfunction after Thoracic Spinal Cord Injury in Yucatan Minipigs. J Neurotrauma 2021; 38:1306-1326. [PMID: 33499736 DOI: 10.1089/neu.2020.7404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
There is an increasing need to develop approaches that will not only improve the clinical management of neurogenic lower urinary tract dysfunction (NLUTD) after spinal cord injury (SCI), but also advance therapeutic interventions aimed at recovering bladder function. Although pre-clinical research frequently employs rodent SCI models, large animals such as the pig may play an important translational role in facilitating the development of devices or treatments. Therefore, the objective of this study was to develop a urodynamics protocol to characterize NLUTD in a porcine model of SCI. An iterative process to develop the protocol to perform urodynamics in female Yucatan minipigs began with a group of spinally intact, anesthetized pigs. Subsequently, urodynamic studies were performed in a group of awake, lightly restrained pigs, before and after a contusion-compression SCI at the T2 or T9-T11 spinal cord level. Bladder tissue was obtained for histological analysis at the end of the study. All anesthetized pigs had bladders that were acontractile, which resulted in overflow incontinence once capacity was reached. Uninjured, conscious pigs demonstrated appropriate relaxation and contraction of the external urethral sphincter during the voiding phase. SCI pigs demonstrated neurogenic detrusor overactivity and a significantly elevated post-void residual volume. Relative to the control, SCI bladders were heavier and thicker. The developed urodynamics protocol allows for repetitive evaluation of lower urinary tract function in pigs at different time points post-SCI. This technique manifests the potential for using the pig as an intermediary, large animal model for translational studies in NLUTD.
Collapse
Affiliation(s)
- Martin S Keung
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Neuroscience, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - April Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Jay Ethridge
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Susan M Dougherty
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Sevda Aslan
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Megan Webster
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shera Fisk
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily G Deegan
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Basile Tessier-Cloutier
- Pathology and Laboratory Medicine, and Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kuan-Yin N Chen
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte Morrison
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elena B Okon
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seth Tigchelaar
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neda Manouchehri
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyoung-Tae Kim
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Neurosurgery, School of Medicine, Kyungpook National University, National University Hospital, Daegu, South Korea
| | - Katelyn Shortt
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kitty So
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot S Damaser
- Biomedical Engineering Department, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Advanced Platform Technology Center, Louis Stokes Cleveland U.S. Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Leslie C Sherwood
- Comparative Medicine Research Unit, and University of Louisville, Louisville, Kentucky, USA
| | - Dena R Howland
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.,Research Service, Robley Rex U.S. Department of Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Max Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Charles Hubscher
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, USA
| | - Lynn Stothers
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Urologic Sciences, and Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Kavanagh
- Urologic Sciences, and Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Soebadi MA, Weydts T, Brancato L, Hakim L, Puers R, De Ridder D. Novel implantable pressure and acceleration sensor for bladder monitoring. Int J Urol 2020; 27:543-550. [PMID: 32266758 DOI: 10.1111/iju.14238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To test the hypothesis that an implantable sensing system containing accelerometers can detect small-scale autonomous movements, also termed micromotions, which might be relevant to bladder physiology. METHODS We developed a 6-mm submucosal implant containing a pressure sensor (MS5637) and a triaxial accelerometer (BMA280). Sensor prototypes were tested by implantation in the bladders of Gottingen minipigs. Repeated awake voiding cystometry was carried out with air-charged catheters in a standard urodynamic set-up as comparators. We identified four phases of voiding similar to cystometry in other animal models based on submucosal pressure. Acceleration signals were separated by frequency characteristics to isolate linear acceleration from the baseline acceleration. The total linear acceleration was calculated by the root mean square of the three measurement axes. Acceleration activity during voiding was investigated to adjacent 1-s windows and was compared with the registered pressure. RESULTS We observed a total of 19 consecutive voids in five measurement sessions. A good correlation (r > 0.75) was observed between submucosal and catheter pressure in 14 of 19 premicturition traces. The peak-to-peak interval between maximum total linear acceleration was correlated with the interval between submucosal voiding pressure peaks (r = 0.760, P < 0.001). The total linear acceleration was higher during voiding compared with pre- and postmicturition periods (start of voiding/phase 1). CONCLUSIONS To the best of our knowledge, this is the first report of bladder wall acceleration, a novel metric that reflects bladder wall movement. Submucosal sensors containing accelerometers can measure bladder pressure and acceleration.
Collapse
Affiliation(s)
- Mohammad Ayodhia Soebadi
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Urology, Dr Soetomo Hospital, Surabaya, Indonesia.,Department of Urology, Airlangga University Hospital, Surabaya, Indonesia.,Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | | | - Lukman Hakim
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Urology, Dr Soetomo Hospital, Surabaya, Indonesia.,Department of Urology, Airlangga University Hospital, Surabaya, Indonesia
| | | | - Dirk De Ridder
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|