Automated closed-loop stimulation to inhibit neurogenic bladder overactivity

Proc Inst Mech Eng H, 2024 · DOI: 10.1177/09544119231172272 · Published: June 1, 2024

Simple Explanation

The study aimed to develop and test an automated system that uses electrical stimulation to control bladder contractions in people with spinal cord injuries. The system uses an algorithm to detect bladder contractions from pressure data and automatically trigger stimulation to stop them, without needing abdominal pressure measurement. The results showed the system successfully identified and inhibited bladder contractions in real time, suggesting it could be a feasible way to manage bladder issues at home.

Study Duration

Not specified

Participants

Four individuals with SCI and NDO

Evidence Level

Not specified

Key Findings

1
The custom algorithm detected bladder contractions in real time, successfully inhibiting a total of 56 contractions across all four subjects.
2
It took approximately 4.0 ± 2.6 s for the algorithm to detect the onset of a bladder contraction and trigger stimulation.
3
Closed-loop GNS resulted in increased capacity and maximum detrusor pressure in all participants compared to trials without GNS.

Research Summary

This study tested the feasibility of automated closed-loop genital nerve stimulation (GNS) using a custom algorithm to identify and inhibit reflex bladder contractions in real time in individuals with spinal cord injury (SCI) and neurogenic detrusor overactivity (NDO). The custom algorithm, uCAT, detected bladder contractions in real time and controlled GNS, successfully inhibiting 56 contractions across four subjects. The algorithm detected contraction onset and triggered stimulation in approximately 4.0 ± 2.6 seconds. Automated closed-loop stimulation was well-tolerated, and subjects reported that algorithm decisions generally matched their perceptions of bladder activity, suggesting the feasibility of this approach for improving bladder control in individuals with SCI and NDO.

Practical Implications

Home Use Potential

The automated closed-loop system could be refined for use in a home environment, potentially improving the quality of life for individuals with SCI and NDO by providing a convenient and effective way to manage bladder overactivity.

Reduced Reliance on Conscious Monitoring

For individuals with intact sensation, the automated system can free them from continuously focusing on bladder sensation, allowing them to engage in other activities without the need to manually trigger stimulation.

Basis for Fully Implanted Systems

The closed-loop strategy can be coupled with other neuromodulation approaches, such as sacral neuromodulation, paving the way for the development of fully implanted systems for bladder control.

Study Limitations

1
Small number of study participants enrolled
2
Urodynamics methods that do not replicate normal bladder conditions
3
Study participants were asked to remain calm and sedentary during data collection procedures

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