Bladder Voiding via Pudendal Nerve Block

通过阴部神经阻滞实现膀胱排尿

• 批准号: 8838092
• 负责人: Kenneth J. Gustafson
• 金额: --
• 依托单位: LOUIS STOKES CLEVELAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-01 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8838092
• 关键词: Action Potentials; Acute; Address; American; Animal Experiments; Animal Model; Animals; Ataxia; Autonomic Dysreflexia; Autopsy; Bilateral; Bladder; Bladder Control; Bladder Dysfunction; Brain Stem Infarctions; Cerebral Palsy; Chronic; Clinical; Clinical Trials; Data; Development; Devices; Disabled Persons; Disease; Dorsal; Economics; Education; Effectiveness; Electric Stimulation; Electrodes; Esthesia; Evaluation; FPS-FES Oncogene; Family; Feasibility Studies; Frequencies; Future; Goals; Grant; Health; Healthcare Systems; Histologic; Hospitalization; Human; Hyperreflexia; Implant; Implanted Electrodes; Incontinence; Individual; Injury; Intestines; Kidney; Kidney Transplantation; Lead; Leisure Activities; Life Style; Lower urinary tract; Measures; Medical; Medical Device; Methods; Modeling; Monitor; Morbidity - disease rate; Motor; Multiple Sclerosis; Muscle Spasticity; Nerve; Nerve Block; Nervous System Trauma; Neurogenic Bladder; Operative Surgical Procedures; Paralysed; Patients; Performance; Personal Satisfaction; Persons; Phase; Plant Roots; Population; Procedures; Production; Prosthesis; Quality of life; Recurrence; Reflex action; Renal dialysis; Research; Research Design; Research Methodology; Rhizotomy procedure; Sacral nerve; Safety; Sensory; Sex Functioning; Societies; Sphincter; Spinal Cord; Spinal cord injury; Stimulus; Stroke; System; Technology; Testing; Tissues; Translating; United States; Urethral sphincter; Urinary Calculi; Urinary tract infection; Urination; Veterans; Work; abstracting; afferent nerve; chronic pain; clinical application; clinically significant; cost; disability; experience; implantable device; improved; nervous system disorder; neural prosthesis; novel strategies; pressure; prevent; programs; reflex urine incontinence; relating to nervous system; response; restoration; social; transmission process; urinary; urologic

Bladder Voiding via Pudendal Nerve Block - Project Summary/Abstract Objectives and Research Aims: Bladder dysfunction after neurological injury or disorders such as spinal cord injury (SCI), brainstem stroke, and multiple sclerosis can have a devastating impact on patients and their families, resulting in a high cost to the individual and to society. The long-term goal of this research program is to develop neural prostheses to restore complete lower urinary tract function in persons with neurological disorders; particularly SCI. These disorders can result in reflex urethral sphincter activity that can prevent voiding and lead to renal damage and autonomic dysreflexia. Surgical section of the urethral sphincter or the pudendal nerves that innervate the sphincter can reduce these complications but may result in loss of urinary and fecal continence, sexual function and sensation. Research Design and Methods: This study proposes a new approach utilizing high frequency (HF) electrical conduction block of the pudendal nerves to produce bladder voiding. Electrical nerve block provides an immediate, reversible approach to block action potential propagation. During our current Merit Review we have demonstrated that HF electrical block of the pudendal nerves, and thereby the external urethral sphincter (EUS) during bladder activation can produce bladder voiding equivalent to pudendal nerve transection. These results demonstrate that electrical nerve block can restore voiding function in acute animal experiments and that a neural prosthesis using pudendal nerve block is feasible. This proposal will conduct the studies needed to translate these results into clinical implementation. Specifically, we will determine the chronic efficacy and safety of this approach to produce voiding in chronic SCI animals that demonstrate bladder-sphincter dyssynergia similar to humans with SCI. Nerve cuff electrodes will be placed on the pudendal nerves to allow HF block of the urethral sphincter, and on the sacral roots to allow bladder drive in animals. Stimulus parameters for effective nerve block and voiding efficacy will be monitored for 8 weeks. Animals that demonstrate stable and effective pudendal HF block and voiding will be spinalized. The implanted electrodes will then be used for voiding; therefore the implanted system will be the primary means of managing bladder function in these animals. The effectiveness of combined pudendal HF pudendal block and sacral root activation to provide bladder emptying will be determined. Nerve function and histologic measures will be used to determine the neural tissue responses to the chronic HF waveforms. Clinical Significance: Successful completion of this project will take an important step towards translating our recent advances discovered in animal models to veterans with SCI. This will support future human feasibility testing of an implanted neural prosthesis able to restore bladder function. This approach is expected to expand the population of individuals who could benefit from neural prostheses to control the bladder, and thereby improve their health and quality of life while reducing costs to the healthcare system. This project will also improve our understanding of HF block that can be expanded to other medical applications such as chronic pain, muscle spasticity in stroke and cerebral palsy.

通过阴部神经阻滞实现膀胱排尿 - 项目摘要/摘要 目的和研究目的：神经损伤或脊髓损伤（SCI）等疾病后的膀胱功能障碍， 脑干中风和多发性硬化症可能对患者及其家人造成毁灭性影响，导致高死亡率 个人和社会的成本。该研究计划的长期目标是开发神经假体 恢复神经系统疾病患者的完整下尿路功能；特别是SCI。这些疾病可以 导致尿道括约肌反射性活动，从而阻止排尿并导致肾损伤和自主神经反射障碍。 尿道括约肌或支配括约肌的阴部神经的手术切除可以减少这些 并发症，但可能导致尿失禁、大便失禁、性功能和感觉丧失。 研究设计和方法：本研究提出了一种利用高频 (HF) 电传导的新方法 阻断阴部神经以产生膀胱排尿。电神经阻滞提供了即时、可逆的 阻止动作电位传播的方法。在我们当前的优点评审中，我们已经证明了高频电气 阴部神经受阻，从而尿道外括约肌 (EUS) 在膀胱激活过程中可产生 膀胱排尿相当于阴部神经横断。这些结果表明电神经阻滞可以 在急性动物实验中恢复排尿功能，并且使用阴部神经阻滞的神经假体是可行的。 该提案将进行将这些结果转化为临床实施所需的研究。具体来说，我们将 确定这种方法在慢性 SCI 动物中产生排尿的长期有效性和安全性，证明 膀胱括约肌协同失调与 SCI 患者相似。神经袖带电极将放置在阴部神经上 允许高频阻滞尿道括约肌，并阻滞骶根以允许动物膀胱驱动。刺激参数 将监测有效的神经阻滞和排尿效果8周。表现出稳定和有效的动物 阴部高频阻滞和排尿将被脊柱化。植入的电极随后将用于排空；因此 植入系统将成为管理这些动物膀胱功能的主要手段。的有效性 将确定联合阴部高频阴部阻滞和骶根激活以提供膀胱排空。神经 功能和组织学测量将用于确定神经组织对慢性高频波形的反应。 临床意义：该项目的成功完成将为转化我们最近的研究成果迈出重要一步。 在动物模型中发现的进步给患有 SCI 的退伍军人带来了好处。这将支持未来的人类可行性测试 植入的神经假体能够恢复膀胱功能。这种方法预计将扩大人口 可以受益于神经假体来控制膀胱，从而改善他们的健康和质量的人 生命，同时降低医疗保健系统的成本。该项目还将提高我们对 HF 块的理解， 扩展到其他医疗应用，例如慢性疼痛、中风引起的肌肉痉挛和脑瘫。