Evaluation of Pudendal Nerve Block for Voiding after Spinal Cord Injury

阴部神经阻滞对脊髓损伤后排尿的评估

• 批准号: 8733435
• 负责人: Graham H Creasey
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8733435
• 关键词: Address; Animal Experimentation; Animal Experiments; Animals; Ataxia; Basic Science; Biomedical Engineering; Bladder; Bladder Control; Cannulas; Caring; Chronic; Clinical; Clinical Research; Decubitus ulcer; Development; Disease; Documentation; Electric Stimulation; Electrodes; Environment; Evaluation; Frequencies; Goals; Health; Healthcare; Healthcare Systems; Human; Impaired health; Implant; Incontinence; Indwelling Catheter; Injection of therapeutic agent; Inpatients; Intestines; Kidney Calculi; Knowledge; Laboratories; Left; Life; Measurement; Measures; Metals; Muscle; Muscle Spasticity; Needles; Nerve; Nerve Block; Neurogenic Bladder; Operative Surgical Procedures; Outcome; Outpatients; Patients; Pharmaceutical Preparations; Physiologic pulse; Pilot Projects; Preparation; Probability; Quality of life; Recording of previous events; Recurrence; Research; Research Personnel; Risk; Sphincter; Spinal cord injury; Stents; System; Techniques; Testing; Time; Toxin; Training; Translating; Urethra; Urethral sphincter; Urinary tract infection; Urine; Veterans; Work; base; care systems; clinical care; clinical practice; cost; design; economic cost; experience; human subject; implantation; improved; innovation; minimally invasive; prevent; public health relevance; success

Spinal cord injury causes many bladder complications for life, such as impaired bladder emptying, recurrent urinary tract infection and stones, kidney damage, and incontinence, which impair health and quality of life and result in considerable cost to health care systems, in spite of state of the art management using medications, appliances and surgery. These complications are often due to unco-ordinated and unwanted contractions of the bladder and the external urethral sphincter, the muscle that restricts the flow of urine out of the bladder through the urethra. Contraction of the sphincter has been managed by cutting the sphincter or the nerves to the sphincter, inserting cylindrical metal mesh "stents" to keep it open, and injection of muscle toxins into the sphincter, but none of these is ideal and some have significant complications, and many patients require intermittent or indwelling catheters to remove urine from the bladder, and these too have their complications. Recently a technique has been developed and refined to block conduction in nerves rapidly and reversibly using electrical stimulation, and this has been used in animals with chronic spinal cord injury to prevent contraction in the pudendal nerves to the sphincter and to allow reliable emptying of the bladder. This project proposes to test this technique for the first time in human subjects with chronic spinal cord injury, using electrodes that can be inserted through a needle and left in place for several days and used to apply electrical stimulation while measuring the ability of human subjects to empty the bladder in the laboratory. After making these measurements the electrodes will be removed by pulling gently on them. If this project is successful it will justify the development and testing of a stimulation system that can be fully implanted by surgery to provide long term management of this problem.

脊髓损伤导致许多膀胱并发症的生活，如受损的膀胱排空，复发性 泌尿道感染和结石、肾损伤和失禁，损害健康和生活质量 并且导致卫生保健系统的相当大的成本，尽管使用了最先进的管理， 药物、器械和手术。 这些并发症通常是由于膀胱和膀胱的不协调和不必要的收缩。 尿道外括约肌，限制尿液通过尿道流出膀胱的肌肉。 括约肌的收缩通过切断括约肌或括约肌的神经来控制， 插入圆柱形金属网“支架”以保持其开放，并将肌肉毒素注入括约肌， 但这些都不是理想的，有些有严重的并发症，许多患者需要间歇性 或留置导尿管从膀胱中排出尿液，这些也有其并发症。 最近，一种技术已经发展和完善，以快速和可逆地阻断神经传导 使用电刺激，这已经被用于慢性脊髓损伤的动物， 收缩的阴部神经括约肌，并允许可靠的排空膀胱。 该项目建议首次在患有慢性脊髓损伤的人类受试者中测试这项技术 损伤，使用可以通过针插入并留在原位数天的电极， 施加电刺激，同时测量人类受试者排空膀胱的能力， 实验室在进行这些测量后，将通过轻轻拉动电极来移除电极。 如果这个项目是成功的，它将证明开发和测试的刺激系统，可以完全 通过手术植入以提供对该问题的长期管理。