Feasibility of Controlled Micturition through Electric Stimulation

Abstract

Historically, man has been aware of bioelectric phenomena for some 4,000 years. Yet it has only been during the last 20 years that technology has advanced to the stage where controlled bladder emptying has become feasible. A great deal of interest followed the introduction of transistor and bladder stimulation via the principle of radio frequency induction. Spinal cord, sacral, and pelvic nerve and direct bladder stimulation have all been attempted. Only direct bladder stimulation in lower motor neuron situations has shown any promise. The many difficulties associated with bladder stimulation include simultaneous sphincter contraction, pain, electrode and insulation difficulties, and fibroplasia due to movement of electrodes placed in pliable tissues. In addition, the role of the prostate, increased urethral length, and erection responses in the male have received little investigation. These problems are outlined and experimental observations of attempts to achieve controlled micturition in canines are presented. These studies were carried out over a 3-year period, and emphasize responses to stimulation of the spinal cord and sacral roots. It was concluded that the most efficient manner by which to effect simulated micturition is via stimulation of the ventral sacral root dominant for bladder responsiveness, and combine this with selective division of somatic fibers of only the root being stimulated.

Re‐operation rates after permanent sacral nerve stimulation for refractory voiding dysfunction in women

“…Sacral nerve stimulation (SNS) involves the stimulation of the sacral nerves to modulate the neural reflexes that influence the bladder, urethral sphincter and pelvic floor [1]. In the early 1980s, the work of Schmidt and Tanagho [2,3] showed that electrical stimulation of the sacral nerve root could reduce inappropriate neural activity, thereby inhibiting the overactive detrusor. This pioneering work in neuromodulation led to clinical trials and subsequently to the Food and Drug Administration approval in 1997 of the InterStim® system (Medtronic, Inc., Minneapolis, MI, USA) for treating refractory urge incontinence.…”

Neuromodulation of voiding dysfunction and pelvic pain

“…A clinical program was initiated by the Urology Department of the University of California at San Francisco (UCSF) in 1981, following an extensive laboratory program [2-4, 12, 13]. Since that time, experience has been gathered in the evaluation, surgery, and follow-up of patients presenting with voiding dysfunction and pelvic pain who have been treated with sacral root electrode implants [7][8][9][10][11]. Urinary urgency, frequency, intermittence, and incontinence as well as burning sensations in the urethra or perineum can be effectively treated with neuromodulation in a high percentage of patients.…”

Forty-five-year follow-up on the renal function after spinal cord injury

“…The sacral nerve stimulation or sacral neuromodulation is based on the research by Schmidt and Tanagho (244). This technique stimulates the afferents and thereby probably restores the correct balance between excitatory and inhibitory impulses from and to the pelvic organs at a sacral and supra-sacral level, thus reducing the DO (28,245).…”