Electrical stimulation for the treatment of bladder dysfunction: Current status and future possibilities

Abstract

Electrical stimulation of peripheral nerves can be used to cause muscle contraction, to activate reflexes, and to modulate some functions of the central nervous system (neuromodulation). If applied to the spinal cord or nerves controlling the lower urinary tract, electrical stimulation can produce bladder or sphincter contraction, produce micturition, and can be applied as a medical treatment in cases of incontinence and urinary retention. This article first reviews the history of electrical stimulation applied for treatment of bladder dysfunction and then focuses on the implantable Finetech-Brindley stimulator to produce bladder emptying, and on external and implantable neuromodulation systems for treatment of incontinence. We conclude by summarizing some recent research efforts including: (a) combined sacral posterior and anterior sacral root stimulator implant (SPARSI), (b) selective stimulation of nerve fibers for selective detrusor activation by sacral ventral root stimulation, (c) microstimulation of the spinal cord, and (d) a newly proposed closed-loop bladder neuroprosthesis to treat incontinence caused by bladder overactivity.

Sacral anterior root stimulated defecation in spinal cord injuries: An experimental study in canine model

“…A recent intraoperative electrical study in patients with spinal cord injury demonstrated that, S3 root was the most efficacious contributor (52.2% of total pressure), S4 was the second but still significant efficacious one (44.9%), and S2 was the last and the least contributor (2.9%) [23] . The S2 root is mainly related to sexual function, and probably serves as a vital pathway for sensory feedback that is necessary for proper function of the viscera, especially for penile sensation, erection and ejaculation [24] . Based on this experimental study, the authors would like to propose a cheaper modification of Brindley's sacral anterior root stimulated micturition and defecation in Asians, i.e., using one cable with two electrodes to trap on the bilateral S3-4 roots [25] .…”

Non-cardiac implantable electrical devices: brief review and implications for anesthesiologists

“…9 However, the indications for sacral nerve stimulation have since been expanded to include neurogenic refractory urge incontinence, interstitial cystitis, pelvic pain, and fecal incontinence. 10 Following a trial with a temporary stimulator that paces the bladder externally through the skin, patients with favorable results undergo surgical implantation of the permanent device, which consists of a lead wire containing four platinum electrodes.…”

Reflexes evoked by electrical stimulation of afferent axons in the pudendal nerve under empty and distended bladder conditions in urethane-anesthetized rats

“…Sacral neuromodulation which involves electrical stimulation of the sacral spinal nerves carrying pudendal nerve afferent axons to the spinal cord is an effective method for suppressing neurogenic bladder problems (Jezernik et al, 2002). In addition modulation of pudendal nerve activity by electrical stimulation or blocking techniques as well as local application of pharmacological agents has been useful for treating voiding dysfunction.…”

“…Neurological disorders such as spinal cord injury disrupt the coordination between the bladder and the urethral outlet leading to voiding dysfunction (detrusor-sphincter-dyssynergia). Studies of the relationship between bladder dynamics (e.g., bladder pressure) and reflex activity in the pudendal nerves innervating the urethral sphincter are essential for developing pharmacological and electrical stimulation-based treatments to control neurogenic voiding dysfunction in spinal cord injured (SCI) patients (Jezernik et al, 2002).…”