Endovascular stimulation of the pudendal nerve using a stent-mounted electrode array

Area of Science:

• Biomedical Engineering
• Neuroscience
• Urology

Background:

• The pudendal nerve is a key target for restoring bladder control.
• Endovascular neurostimulation offers a less invasive alternative to conventional implanted electrodes.
• The proximity of the pudendal nerve to blood vessels enables endovascular approaches.

Purpose of the Study:

• To investigate the feasibility of endovascular excitatory stimulation and kilohertz-frequency nerve block of the pudendal nerve in sheep.
• To evaluate a custom-made stent-mounted electrode array for endovascular neurostimulation.
• To assess the potential of this technique for treating urinary incontinence and bladder-sphincter dyssynergia.

Main Methods:

• Acute animal experiments were conducted in sheep.
• A hexapolar electrode catheter was introduced into the internal pudendal artery for bipolar electrical stimulation.
• A custom stent-mounted electrode array was tested as a replacement for the catheter electrode.
• Pelvic floor and sphincter muscle activity was recorded via urethral electromyography.

Main Results:

• Endovascular stimulation of the pudendal nerve was feasible with both electrode types.
• Stimulation threshold current was affected by electrode-nerve distance and orientation.
• Increased inter-electrode distance reduced threshold current.
• Kilohertz-frequency endovascular nerve block was achieved using the electrode catheter.

Conclusions:

• Endovascular stimulation with a stent-mounted electrode array is a promising, less invasive alternative to conventional electrodes for pudendal nerve neuromodulation.
• This technique has significant clinical implications for treating urinary incontinence.
• Endovascular pudendal nerve block could offer a solution for bladder-sphincter dyssynergia in spinal cord injury patients.