Detecting Bladder Biomarkers for Closed-Loop Neuromodulation: A Technological Review

Park, Eun-Kyoung; Lee, Jae-Woong; Kang, Minhee; Cho, Kyeongwon; Cho, Baek Hwan; Lee, Kyu‐Sung

doi:10.5213/inj.1836246.123

Cited by 14 publications

(5 citation statements)

References 61 publications

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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. mice, rats, cats, and pigs).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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

View full text Add to dashboard Cite

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“…Electromyography is not suitable for TAUDM because the recorded signal is of very small amplitude and the electrodes need to be implanted. 56 Cystometry and volume measurement are the only UDS steps that can be reproduced for TAUDM. Thus, the bladder pressure and post-void urinary volume are efficient biomarkers for the assessment of bladder function during UDS.…”

Section: Potential Wireless and Catheter-free Devices For Telemetric ...mentioning

confidence: 99%

“…The most promising biomarkers are currently the measurement of bladder pressure or the detection of bladder events based on an analysis of afferent nerve activity from the bladder to the brain. 56 , 86 This last method is invasive and excessive in the diagnostic setting of UDS but may be relevant for long-term closed-loop systems.…”

Section: Conceivable Bionic Solutionsmentioning

confidence: 99%

Catheter-Free Urodynamics Testing: Current Insights and Clinical Potential

Vogt

2024

RRU

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Lower urinary tract dysfunction not only interferes with the health-related quality of life of patients but may also lead to acute kidney injury and infections. To assess the bladder, urodynamic studies (UDS) have been implemented but the use of catheters leads to discomfort for the patient. Catheter-free long-term UDS would be useful and a potential solution could be ambulatory wireless devices that communicate via telemetry. Such sensors can detect pressure or volume. Numerous types of potential catheter-free sensors have been proposed for bladder monitoring. Despite substantial innovation in the manufacturing of implantable biomedical electronic systems, such sensors have remained at the laboratory stage due to a number of critical challenges. These challenges primarily concern hermeticity and biocompatibility, sensitivity and artifacts, drift, telemetry, and energy management. Having overcome these challenges, catheter-free ambulatory urodynamic monitoring could combine a synchronized intravesical pressure sensor with a volume analyzer but only the steps of cystometry and volume measurement are currently sufficiently reproducible to simulate UDS results. The measurement of volume by infrared optical sensors, in the form of abdominal patches, appears to be promising and studies are underway to market a telemetric ambulatory urodynamic monitoring system that includes an intravesical pressure sensor. There has been considerable progress in wearable and conformable electronics on many fronts, and continued collaboration between engineers and urologists could quickly overcome current challenges. In addition, to the diagnosis of UDS, such sensors could be useful in the development of a long-term closed-loop neuromodulation system. In this review, we explore the various types of catheter-free bladder sensors, inherent challenges and solutions to overcome these challenges, and the clinical potential of such long-term implantable sensors.

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“…This is an important issue for male patients. Therefore, other techniques, which avoided posterior rhizotomy and spared intact nerves were developed, but still usually involved open surgical implantation [ 39 ]. New treatment options attempt to overcome remaining obstacles in neuromodulation by using a transcutaneous approach instead of open procedures [ 40 ].…”

Section: Engineering Innovationsmentioning

confidence: 99%

Spinal cord injury and neurogenic lower urinary tract dysfunction: what do we know and where are we going?

Dodd¹,

Motwani²,

Small³

et al. 2022

JOMH

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One of the well reported but difficult to manage symptoms of spinal cord injury (SCI) is neurogenic lower urinary tract dysfunction (NLUTD). The type of NLUTD is variable based on location and extent of injury. SCI affects more males and NLUTD is especially debilitating for men with incomplete injury. This review summarizes the anatomical basis of NLUTD in SCI and discusses current diagnostic and management strategies that are being utilized clinically. The last two sections address new innovations and emerging discoveries with the goal of increasing scientific interest in improving treatment options for people with SCI. Areas warranting further investigation are pinpointed to address current gaps in knowledge and/or appropriate technology.

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Detecting Bladder Biomarkers for Closed-Loop Neuromodulation: A Technological Review

Cited by 14 publications

References 61 publications

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

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

Catheter-Free Urodynamics Testing: Current Insights and Clinical Potential

Spinal cord injury and neurogenic lower urinary tract dysfunction: what do we know and where are we going?

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