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Closed loop electrical control of urinary continence.

Brian J Wenzel1, Joseph W Boggs, Kenneth J Gustafson

  • 1Departments of Biomedical Engineering, Duke University, Durham, North Carolina, USA.

The Journal of Urology
|March 7, 2006
PubMed
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Conditional electrical stimulation, applied only when bladder contractions begin, improves bladder capacity more effectively than continuous stimulation for neurogenic detrusor overactivity. This approach maintains continence with reduced stimulation time.

Area of Science:

  • Neuroscience
  • Urology
  • Biomedical Engineering

Background:

  • Neurogenic detrusor overactivity (NDO) in spinal cord injury and neurological disorders causes incontinence due to low-volume bladder contractions.
  • Continuous electrical stimulation of inhibitory pathways can suppress NDO but may lead to reflex habituation and loss of efficacy.
  • Maintaining continence requires effective suppression of involuntary bladder contractions without compromising long-term reflex function.

Purpose of the Study:

  • To evaluate if conditional electrical stimulation, triggered at the onset of bladder contractions, enhances bladder capacity compared to continuous stimulation.
  • To determine if this conditional approach improves continence in the presence of NDO.
  • To assess the reduction in stimulation time achieved by a conditional, event-triggered system.

Related Experiment Videos

Main Methods:

  • Cystometry was performed in anesthetized cats to compare continence under no stimulation, continuous stimulation, and conditional electrical stimulation.
  • Pelvic nerve electrical activity (PNT ENG) was used to detect nascent bladder contractions.
  • An event-triggered control system regulated conditional stimulation based on PNT ENG signals to maintain continence.

Main Results:

  • Conditional stimulation increased bladder capacity by 36% compared to no stimulation (p <0.001).
  • Bladder capacity was improved by 15% with conditional stimulation versus continuous stimulation (p <0.027).
  • The event-triggered system reduced overall stimulation time by 67% compared to continuous stimulation.

Conclusions:

  • Conditional electrical stimulation of inhibitory pathways is superior to continuous stimulation for managing NDO.
  • An event-triggered control system utilizing PNT ENG effectively maintains urinary continence.
  • This strategy offers a more efficient method for suppressing bladder hyperreflexia.