High-density spinal cord stimulation selectively activates lower urinary tract afferents

Abstract

Epidural spinal cord stimulation (SCS) has recently been reported as a potential intervention to improve limb and autonomic functions, with lumbar stimulation improving locomotion and thoracic stimulation regulating blood pressure. We asked whether sacral SCS could be used to target the lower urinary tract. Here we show that high-density epidural SCS over the sacral spinal cord and cauda equina of anesthetized cats evokes responses in nerves innervating the bladder and urethra and that these nerves can be activated selectively. Sacral epidural SCS always recruited the pelvic and pudendal nerves and selectively recruited these nerves in all but one animal. Individual branches of the pudendal nerve were always recruited as well. Electrodes that selectively recruited specific peripheral nerves were spatially clustered on the arrays, suggesting anatomically organized sensory pathways. This selective recruitment demonstrates a mechanism to directly modulate bladder and urethral function through known reflex pathways, which could be used to restore bladder and urethral function after injury or disease.

High-density spinal cord stimulation selectively activates lower urinary tract nerves

“…The data that support the findings of this study are openly available at the following URL/DOI: https:// doi.org/10.26275/hbuu-caud. This dataset also contains data from other experiments; animals 1-6 described in this study are referred to in the dataset in order as subjects 54, 60, 64, 63, 68, 69, and 78. The data that support the findings of this study are openly available at the following URL/DOI: https:// doi.org/10.26275/hbuu-caud [71].…”

A Computational Study of Lower Urinary Tract Nerve Recruitment with Epidural Stimulation of the Lumbosacral Spinal Cord

“…Experimental data used for validation of model results had been previously collected in 6 cats. In these experiments, we stimulated using a 24-channel SCS array (Micro-Leads, Inc.) and recorded action potentials from nerve cuffs (Micro-Leads, Inc.) on the pelvic, pudendal, and sciatic nerves [1]. In the…”

“…Figure 2a shows an example recruitment curve generated at the rostral placement in the computational model. Figure 2b shows an example recruitment curve generated at that same electrode placement selective for the pudendal nerve generated by SCS in a cat [1].…”

“…However, existing interventions to address this dysfunction are insufficient and only manage symptoms. Recently, we demonstrated in an animal model that epidural spinal cord stimulation (SCS) activates the nerves of the lower urinary tract [1] and evokes bladder reflexes that control both continence and voiding. In order to translate this technology to humans, it is critical to establish SCS locations and stimulation parameters to best target the bladder.…”