Feasibility of Real-Time Conditional Sacral Neuromodulation Using Wireless Bladder Pressure Sensor.

Area of Science:

• Biomedical Engineering
• Neuroscience
• Urology

Background:

• Continuous sacral neuromodulation (SNM) treats overactive bladder by reducing leakage and increasing bladder capacity.
• Conditional SNM offers power savings and personalized treatment by responding to real-time bladder changes.

Purpose of the Study:

• To demonstrate the feasibility of a closed-loop conditional SNM system using a wireless bladder pressure sensor and real-time algorithm.
• To assess the system's ability to automatically trigger neuromodulation based on bladder pressure.

Main Methods:

• Developed and tested a closed-loop system integrating a wireless bladder pressure sensor, control algorithm, and research neurostimulator.
• Evaluated four conditional SNM paradigms over five days in four female sheep.
• Assessed system performance, including sensor accuracy, stimulation command latency, and bladder capacity changes.

Main Results:

• The wireless bladder pressure sensor showed moderate correlation with catheter-based measurements (median r = 0.52).
• The system successfully and automatically triggered SNM with high command execution (98.5%) and low latency (median 72 ms).
• Both continuous and conditional SNM increased bladder capacity, with some animals showing stronger responses to conditional paradigms.

Conclusions:

• A closed-loop conditional SNM system is feasible for automated neuromodulation.
• Individualized responses suggest potential for personalized overactive bladder treatment.
• Further research can explore physiological mechanisms and clinical translation of conditional SNM.