State-dependent bioelectronic interface to control bladder function

Hokanson, Jim; Langdale, Christopher L.; Sridhar, Arun; Milliken, Phil; Grill, Warren M.

doi:10.1038/s41598-020-79493-7

Cited by 12 publications

(15 citation statements)

References 40 publications

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“…The pudendal nerve gives rise to perineal and dorsal genital branches within the pudendal canal [29]. Depending on the stimulation frequency and the state of the bladder, stimulation of the pudendal afferents may produce an excitatory or inhibitory effect on bladder contraction [39,49]. This reflex persists after a spinal cord injury, indicating that it most likely only relies on spinal circuitry and not supraspinal control [50], rendering electrical stimulation of the pudendal nerve a promising technique to restore bladder functions in patients with spinal cord injuries.…”

Section: Limited Fascicular Selectivity With the Endovascular Approachmentioning

confidence: 99%

Computational modeling of endovascular peripheral nerve stimulation using a stent-mounted electrode array

et al. 2023

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Objective: Endovascular neuromodulation has attracted substantial interest in recent years as a minimally invasive approach to treat neurological disorders. In this study, we investigated with a computational model the feasibility of stimulating peripheral nerves with an endovascular stent-mounted electrode array. Approach: Anatomically realistic FEM models were constructed for the pudendal and vagal neurovascular bundles. The electromagnetic fields generated from electrical stimuli was computed using Sim4Life NEURON models to predict dynamic axonal responses. Main results: The models predict that the stimulation thresholds of the endovascular stent-electrode array configurations tested are comparable to that of ring electrodes and are dependent on the inter-electrode distance and orientation of the device. Arranging multiple electrodes along the longitudinal axis of the nerve lowers surface charge density without sacrificing axon recruitment, whereas arranging electrodes along the circumference of the blood vessel reduces the risk of misalignment but lowers axon recruitment. Significance: Overall, this study predicts that the endovascular stent-electrode array is a feasible stimulation option for peripheral nerves, and the electrode array can be flexibly optimized to achieve the lowest stimulation threshold.

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Section: Limited Fascicular Selectivity With the Endovascular Approachmentioning

confidence: 99%

Computational modeling of endovascular peripheral nerve stimulation using a stent-mounted electrode array

et al. 2023

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“…According to the most widely recognized explanation, neuromodulations interrupt or interfere with the afferent nerve input to the sacral spinal cord, limiting detrusor overactivity and resulting in clinical alleviation of urine frequency and urgency [ 31 , 32 ]. Electrical stimulation of the pelvic nerve, pudendal nerve sensory fibers, or muscular nerve fibers from lower limbs like the posterior tibial nerve can inhibit spinal micturition centers [ 33 , 34 ]. Fine needles are used to stimulate the Sanyinjiao point (SP-6), in which is located four fingers' breadth above the medial malleolus (SP-6).…”

Section: Micturition Reflex and Neuromodulation Mechanismmentioning

confidence: 99%

Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines

Al-Danakh

Safi

Alradhi

et al. 2022

Parkinson's Disease

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Purpose of the Review. Posterior tibial nerve stimulation (PTNS) techniques have dramatically grown after approval to manage overactive bladder (OAB). The present review will focus on the most current data on PTNS types (percutaneous, transcutaneous, and implant) and their mechanism of action, safety, efficacy, advantages, drawbacks, limitation, and clinical applications. Recent Findings. The present review described the recent studies that addressed the tibial nerve stimulation role in OAB management. BlueWind RENOVA system, Bioness StimRouter, and eCoin are examples of emerging technologies that have evolved from interval sessions (percutaneous PTNS and transcutaneous PTNS) to continuous stimulation (implants). These can be efficiently managed at home by patients with minimum burden on the health system and fewer visits, especially in the COVID-19 pandemic. Summary. Our review shows that the tibial nerve stimulation advancements in OAB treatment have been rapidly increasing over the recent years. It is minimally invasive and effective, similar to sacral nerve stimulation (SNM), but less aggressive. Implantable PTNS has been promised in terms of efficacy, safety, and high acceptance rate. However, evidence is still limited to short-term trials, and tolerability, method, and drawbacks remain challenges.

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“…A switch from the filling phase to the emptying phase occurs when tension in the bladder stimulates stretch receptors (which are slowly adapting mechanoreceptors). 24 Inhibition of the parasympathetic nerves that innervate the bladder is the mechanism by which anticholinergics, opioids, and anesthetics cause urinary retention. 25 , 26 There are numerous signaling molecules secreted by the urinary epithelium (including acetylcholine, nitric oxide, neuropeptides, neurotrophins, and prostaglandins) which form the “uroepithelium-associated sensory network”, with ATP serving as the main messenger for the voiding reflex and pain.…”

Section: Discussionmentioning

confidence: 99%

Effect of Transcutaneous Acupoint Electrical Stimulation on Urinary Retention and Urinary ATP in Elderly Patients After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Trial

Zhang¹,

Gong²,

Zhang³

et al. 2022

CIA

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Purpose To investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on urinary retention after laparoscopic cholecystectomy in elderly patients, and to explore the relationship between TEAS and urinary ATP. Patients and Methods The TEAS group was administered active TEAS at specific acupuncture points prior to induction of anesthesia and continued for 45 mins after surgery. In the control group, participants received sham stimulus at the same acupoints and no output current was delivered by disconnecting the device’s output line. Urine samples were collected and evaluated in the first spontaneous voiding after surgery. In this study, postoperative urinary retention (POUR) was the primary outcome, which was diagnosed based on clinical symptoms, ultrasound assessments, and the need for bladder catheterization. Secondary outcomes include urinary ATP, postoperative spontaneous urination, urination symptoms, catheter-related bladder discomfort (CRBD), delirium, duration and hospitalization costs. Results The study involved 598 patients recruited and randomized between August 2018 and June 2020. Among these patients, 547 (91.5%) completed the study and were analyzed. There were 64 cases of POUR, including 23 (8.4%, 95% confidence interval [CI]: 6.4–9.9%) in the TEAS group and 41 (15.0%, 95% CI: 9.3–13.4%) in the control group (p = 0.017). A significant difference was observed between the TEAS and control groups for urinary ATP concentration in the first spontaneous urine postoperatively (344 nmol/L versus 233 nmol/L, p=0.001). There was a shorter spontaneous voiding recovery time, smaller voiding threshold, less postoperative catheterization, less CRBD, and lower hospitalization costs in TEAS group compared with control group. Conclusion TEAS reduces the incidence of POUR in elderly patients undergoing laparoscopic cholecystectomy, which may be related to an increase in bladder ATP release.

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State-dependent bioelectronic interface to control bladder function

Cited by 12 publications

References 40 publications

Computational modeling of endovascular peripheral nerve stimulation using a stent-mounted electrode array

Computational modeling of endovascular peripheral nerve stimulation using a stent-mounted electrode array

Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines

Effect of Transcutaneous Acupoint Electrical Stimulation on Urinary Retention and Urinary ATP in Elderly Patients After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Trial

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