Is submucosal bladder pressure monitoring feasible?

Abstract

Introduction: There has been recent interest in placing pressure sensing elements beneath the bladder mucosa to facilitate chronic bladder pressure monitoring. Wired submucosal sensors with the wires passed through detrusor have been demonstrated in vivo, with limited chronic retention, potentially due to the cable tethering the detrusor. Published studies of submucosal implants have shown that high correlation coefficients between submucosal and lumen pressures can be obtained in caprine, feline, and canine models. We have developed a wireless pressure monitor and surgical technique for wireless submucosal implantation and present our initial chronic implantation study here. Methods: Pressure monitors were implanted (n=6) in female calf models (n=5). Five devices were implanted cystoscopically with a 25-Fr rigid cystoscope. One device was implanted suprapubically to test device retention with an intact mucosa. Wireless recordings during anesthetized cystometry simultaneous with catheter-based reference vesical pressure measurements during filling and manual bladder compressions were recorded. Results: Individual analysis of normalized data during bladder compressions (n=12) indicated high correlation (r=0.85–0.94) between submucosal and reference vesical pressure. The healing response was robust over 4 weeks; however, mucosal erosion occurred 2–4 weeks after implantation, leading to device migration into the bladder lumen and expulsion during urination. Conclusions: Wireless pressure monitors may be successfully placed in a suburothelial position. Submucosal pressures are correlated with vesical pressure, but may differ due to biomechanical forces pressing on an implanted sensor. Fully wireless devices implanted beneath the mucosa have risk of erosion through the mucosa, potentially caused by disruption of blood flow to the urothelium, or an as-yet unstudied mechanism of submucosal regrowth. Further investigation into device miniaturization, anchoring methods, and understanding of submucosal pressure biomechanics may enable chronic submucosal pressure monitoring. However, the risk of erosion with submucosal implantation highlights the need for investigation of devices designed for chronic intravesical pressure monitoring.

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“…In the last week, pressure measurements showed a similar range of correlations with the initial measurements. The characteristics of submucosal pressure measurement were consistent with results previously published 11,21 …”

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“…Intravesical devices ranging in diameter from 15 to 21 Fr (REFS 40,41,47,48 ) are suitable for urethral insertion, and some prototypes have been transurethrally placed in urological training mannequins 41 and into the bladders of large animals (calves, swine and minipigs) 47,48 . Other devices proposed for intravesical use are much larger than urological cystoscopes or drainage catheters, ranging from 27 to 48 Fr in diameter [42][43][44][45][46] , and are, therefore, not amenable for transurethral insertion.…”

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