Pudendal nerve mapping towards improved neuromodulation for urinary retention

我们的目标医疗条件是逼尿肌活动不足，膀胱的问题， 这些人不能有效地排空他们的膀胱。这是一个广泛的临床 这个问题得到的关注远远少于膀胱过度活动症和尿失禁的情况。我们 建议使用神经调节阴部神经，Medtronic Interstim植入式 神经刺激器，以评估接受刺激的患者的刺激驱动排尿 刺激器作为治疗膀胱问题。我们预计，这项研究代表了一个低水平， 风险。虽然我们正在研究一种植入物，但Interstim器械已获得FDA的批准， 研究条件下，我们已经在该位置植入器械， 使用.我们将使用成像和电生理学来绘制十名患者的阴部神经 接受植入物。接下来，我们将创建植入物的患者特定计算模型 和神经，使我们能够模拟最佳刺激范例， 阴部神经的通路这些最佳范例将在后续测试中进行评估 我们将寻求驱动膀胱排尿反应。最后两 这项研究的参与者将有逼尿肌活动不足，使我们能够评估我们的 这种方法在目标患者群体中有效。我们的研究成果将包括证明 成功驱动膀胱收缩和排尿，创建经验证的患者特异性 阴部神经刺激的计算模型，以及阴部神经解剖的映射。 图1显示了我们的总体研究设计，以及我们预期研究的示例图 我们的团队为另一种神经调节方法实施的进展[1]。 该计划的一个主要目标是提高解剖学知识， 自主器官的功能性神经支配朝向改进的神经调节疗法。 我们相信我们的项目完全符合这一目标，因为我们将使用成像， 电生理学技术，以在相关临床中映射支配盆腔器官的关键神经 人口整个项目的主要成果将是一个模拟 在末端器官上的用户选择的神经调节治疗。我们的计划是进行患者特异性 阴部神经神经调节的建模直接与该程序结果一致， 可以直接集成在模拟器内。

Our targeted medical condition is detrusor underactivity, a bladder problem in which individuals are unable to effectively empty their bladder. This is a widespread clinical problem that receives far less attention than overactive bladder and incontinence conditions. We propose to use neuromodulation of the pudendal nerve, with the Medtronic Interstim implantable neurostimulator, to evaluate stimulation-driven voiding in patients that are receiving the stimulator as a treatment for bladder problems. We expect that this study represents a low level of risk. Although we are studying an implant, the Interstim device is approved by the FDA for the conditions under study and we are already implanting the device at this location, in an off-label use. We will use imaging and electrophysiology to map the pudendal nerve in ten patients receiving the implant. Next, we will create patient-specific computational models of the implant and nerve, allowing us to simulate optimal stimulation paradigms for recruiting bladder excitation pathways in the pudendal nerve. These optimal paradigms will be evaluated in a follow-up test session with patients in which we will seek to drive bladder voiding responses. The final two participants in this study will have detrusor underactivity, allowing us to evaluate whether our approach works in the target patient group. Our study outcomes will include demonstrating successfully-driven bladder contractions and voiding, creating validated patient-specific computational models of pudendal nerve stimulation, and mapping pudendal nerve anatomy. Figure 1 shows our overall study design, with example figures of our anticipated study progression as implemented for another neuromodulation approach by our team [1]. A primary objective of the SPARC program is to enhance knowledge of anatomical and functional neural innervation of autonomic organs towards improved neuromodulation therapies. We believe our project aligns perfectly with this objective, as we will use imaging and electrophysiology techniques to map a key nerve innervating pelvic organs in a relevant clinical population. A principal outcome of the entire SPARC program will be a model for simulating a user-selected neuromodulation therapy on an end organ. Our plan to perform patient-specific modeling of pudendal nerve neuromodulation directly aligns with this program outcome, and may integrate directly within that simulator.