Closed-loop stimulation of the pelvic nerve for optimal micturition

Peh, Wendy Yen Xian; Raczkowska, Marlena N.; Teh, Y. F.; Alam, Monzurul; Thakor, Nitish V.; Yen, Shih Cheng

doi:10.1088/1741-2552/aadee9

Cited by 12 publications

(10 citation statements)

References 88 publications

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“…We may use "dystrophic neuritic nest" or "dystrophic neuritic plexus" to describe the format or profile of the curl-up neurites and coiled neurites. For control of the micturition process, the several routes relate a closed loop system [49,50]. N-d neurons involve the autonomic input fibers and preganglionic output.…”

Section: Discussionmentioning

confidence: 99%

Spacing spheroids, curl-up and coiled neuritic plexus of the sacral spinal cord of aged dog: Hypothesis based on continued NADPH diaphorase histological observations

Jia

Hou

et al. 2020

Preprint

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NADPH diaphorase (N-d) neurons distribute in spinal cord and function for visceral sensation and autonomic regulation. N-d positive neurons innervate pelvic organs. In previous investigation, we report that aging-related N-d body (ANB) in the lumbosacral spinal cord in aged rat and megaloneurite in the sacral spinal cord in aged dog. This article was a continued data report of aging-related N-d alterations in aged dog. N-d positivity in aged spinal cord has revealed a certain of morphological profiles in the spinal cord of several species. However, we still found some denoted N-d neurodegenerative changes that we failed to notice in our previous studies when reexamination of the sacral spinal cord of aged dog. In the horizontal section, spacing spheroids in the superficial laminae of the dorsal horn, curl-up and coiled neurites in the intermediate zone were detected in the sacral spinal cord. The ANB and vacuolar neurite were also detected. Vacuolar degeneration also occurred in the dorsal ganglia at the sacral segment. The curl-up and coiled neurites did not occur in the lumbothoracic segment, but the ANB and vacuolar neurite were scatteringly detected in in the lumbothoracic segment of aged dog. The results suggested that the N-d sensory inputs interrupted and disconnected with integration of autonomic centers and output circuits of regulating urogenital organs during the aging. These specialized profiles were speculated that the N-d neurite deterioration of visceral sensory circuit implicated dysfunction of pelvic organs in the aging. Megaloneurite and fiber dilation may make backward reasoning to N-d fiber architecture under normal condition.Urinary incontinence is clinical epidemiological health issues of older adults[1] Constipation is also common in adults older than 60 years [2]. Generally, constipation is considered for the peripheral enteric neurodegeneration [3,4]. Erectile dysfunction in men is also a sign of an underlying aging condition [5]. The sensation of the aging spinal cord could be changed in the singling circuitry in the dorsal horn of the lumbosacral segment [6]. The impact of aging on the cellular composition of the spinal cord reveals aging-associated changes in the numbers of neurons and non-neuronal cells [7].The sacral spinal cord innervates of the urogenital organs [8,9]. The relevant cell bodies of autonomic neurons distribute in the dorsal horn, intermediolateral nucleus (IML), dorsal commissural nucleus (DCN). In the dog [9, 10] and monkey [11], autonomic neurons also locate in the anterior horn. Many neuropeptides distribute in these neurons [12,13]. The NADPH diaphorase (N-d) is also important neuronal enzyme identical to nitric oxide synthase (NOS) distributed in the autonomic spinal cord[14-16], although some experiments may not completely reach the consistent conclusion [17][18][19][20]. Up to date, the N-d is also commonly used to investigate the neurodegenerative diseases[21-23]. Aging-related N-d alterations have been studied in the sacral spinal cord in the rat [18], dog[2...

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Section: Discussionmentioning

confidence: 99%

Spacing spheroids, curl-up and coiled neuritic plexus of the sacral spinal cord of aged dog: Hypothesis based on continued NADPH diaphorase histological observations

Jia

Hou

et al. 2020

Preprint

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“…While on-demand pelvic nerve stimulation at prestipulated timepoints can help to empty the bladder, available on-line information about the fullness of the bladder could enable more flexible on-demand scheduling, and more effective delivery of stimulation under a closed-loop neuromodulation scheme 21 . Other than implanting devices that detect bladder size or pressure changes directly 32 , previous studies have shown that it was possible to correlate intravesical pressures with in vivo neural recordings obtained from the pelvic nerve [33][34][35] , pudendal nerve 36 , dorsal root ganglion 37 , and lumbar/sacral roots [38][39][40][41] in various species (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…A graphic user interface on a laptop was used to set stimulation parameters, and initiate stimulation on-demand via a wireless link to the external device which then sent data and power to the stimulator. Based on results from a prior study on electrical stimulation of the pelvic nerve 21 , we decided to employ a multi-train stimulation approach to void the bladder. At each bihourly stimulation timepoint (i.e.…”

Section: Electrical Stimulation Of Pelvic Nerve In Awake Sci Ratsmentioning

confidence: 99%

Neuromodulation of pelvic nerve during early phase of spinal cord injury in rats using implantable prototype devices - a preliminary study

Peh

Alam

Ahmed

et al. 2019

Preprint

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ObjectivesThe bladder becomes retentive during the early phase of spinal cord injury, and requires proper bladder management to prevent damage to the lower urinary tract and kidney. We investigated the effects of on-demand pelvic nerve stimulation on the areflexive bladder during the earliest phase of complete spinal cord injury in rats and the use of pelvic nerve signals as a proxy to estimate intravesical pressure for closed-loop applications. Materials and MethodsIn order to stimulate the pelvic nerves in female Sprague-Dawley rats with complete spinal cord transection (T7 level), a flexible electrode was implanted unilaterally on pelvic nerve, and electrical stimulation was provided by a custom-built nerve stimulator. Stimulationevoked voiding was monitored in the awake state while size, capacity and spontaneous contractions of the bladder were analysed under anaesthesia. Separately, recordings of the pelvic nerve signals, external urethral sphincter activity and intravesical pressure were performed in animals with intact and transected spinal cord under anaesthesia. ResultsSuccessful pelvic nerve stimulation enabled more frequent voiding, reduced overdistension of bladder, and preserved non-voiding spontaneous bladder contractions.Typical bladder management protocol for SCI rats (manual expression every 8 -12 hours) resulted in more severe bladder overdistention. Signal processing of the recorded extraneural pelvic nerve signals successfully reconstructed changes in intravesical pressure, demonstrating their use in estimating the fullness and contractions of the bladder. ConclusionsThe preliminary results suggest that pelvic nerve stimulators can serve as an alternative method for frequent emptying of the areflexive bladder. Simultaneous recording of the same pelvic nerve will be useful for development of a closed-loop neuroprosthesis.

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“…All the aforementioned methods are based on the open-loop control manner. A closed-loop control has been proposed for control of bladder function while the intravesical pressure (IVP) has been employed as the feedback information 32,33 . Two pressure thresholds were defined to trigger the low-frequency continuous PN stimulation and intermittent high-frequency pudendal afferent stimulation.…”

Section: A General Framework For Automatic Closed-loop Control Of Blamentioning

confidence: 99%

A general framework for automatic closed-loop control of bladder voiding induced by intraspinal microstimulation in rats

Yousefpour

Erfanian

2021

Sci Rep

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Individuals with spinal cord injury or neurological disorders have problems in voiding function due to the dyssynergic contraction of the urethral sphincter. Here, we introduce a closed-loop control of intraspinal microstimulation (ISMS) for efficient bladder voiding. The strategy is based on asynchronous two-electrode ISMS with combined pulse-amplitude and pulse-frequency modulation without requiring rhizotomy, neurotomy, or high-frequency blocking. Intermittent stimulation is alternately applied to the two electrodes that are implanted in the S2 lateral ventral horn and S1 dorsal gray commissure, to excite the bladder motoneurons and to inhibit the urethral sphincter motoneurons. Asynchronous stimulation would lead to reduce the net electric field and to maximize the selective stimulation. The proposed closed-loop system attains a highly voiding efficiency of 77.2–100%, with an average of 91.28 ± 8.4%. This work represents a promising approach to the development of a natural and robust motor neuroprosthesis device for restoring bladder functions.

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Closed-loop stimulation of the pelvic nerve for optimal micturition

Abstract: This novel approach may be applied to an implantable device for treating underactive bladder (<60% VE), especially in cases where under- or over-stimulation of the nerve is a concern.

Cited by 12 publications

References 88 publications

Spacing spheroids, curl-up and coiled neuritic plexus of the sacral spinal cord of aged dog: Hypothesis based on continued NADPH diaphorase histological observations

Spacing spheroids, curl-up and coiled neuritic plexus of the sacral spinal cord of aged dog: Hypothesis based on continued NADPH diaphorase histological observations

Neuromodulation of pelvic nerve during early phase of spinal cord injury in rats using implantable prototype devices - a preliminary study

A general framework for automatic closed-loop control of bladder voiding induced by intraspinal microstimulation in rats

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