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Related Concept Videos

The Micturition Reflex01:26

The Micturition Reflex

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Urination, or micturition involves the coordination of the bladder's detrusor muscle and two sphincters to ensure controlled bladder emptying.
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating...
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Sensing in Sacral Neuromodulation: A Feasibility Study in Subjects With Urinary Incontinence and Retention.

Colin Goudelocke1, Lisa M Jungbauer Nikolas2, Katie C Bittner2

  • 1Department of Urology, Ochsner Medical Center, New Orleans, LA, USA.

Neuromodulation : Journal of the International Neuromodulation Society
|August 17, 2023
PubMed
Summary

Sacral neuromodulation (SNM) therapy can be optimized by automatically detecting sacral evoked responses (SERs). This study confirmed SERs are detectable using implanted leads, offering a potential objective measure for consistent SNM therapy.

Keywords:
CMAPECAPsacral evoked responsesacral neuromodulationsensing

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Area of Science:

  • Biomedical Engineering
  • Neuroscience
  • Urology

Background:

  • Current sacral neuromodulation (SNM) therapy optimization relies on subjective visual-motor and patient-reported sensory feedback.
  • Objective, automated detection of stimulation responses could enhance SNM therapy consistency and efficacy.

Purpose of the Study:

  • To measure and characterize sacral evoked responses (SERs) elicited by sacral nerve stimulation.
  • To evaluate the feasibility of using a commercial, tined SNM lead for SER detection.

Main Methods:

  • A custom research system recorded SERs during intraoperative and postoperative sessions in 21 subjects with overactive bladder (OAB) and nonobstructive urinary retention (NOUR).
  • Recordings were made across various stimulation settings and electrode configurations, alongside motor and sensory threshold measurements.

Main Results:

  • Sacral evoked responses (SERs) were successfully detected in all 21 subjects.
  • SER morphology varied, but responses were present at motor and/or sensory thresholds in 75-80% of subjects.
  • SERs were detectable at standard SNM stimulation parameters and procedural time points.

Conclusions:

  • Implanted SNM leads can directly record stimulation-elicited SERs in patients with OAB and NOUR.
  • SERs provide a detectable, objective measure for optimizing SNM lead placement and programming.
  • Automated SER detection holds potential for patient-specific, closed-loop SNM therapy.