Neuromodulation of Individual Pelvic Floor Muscle Activity in Urinary Incontinence

尿失禁中个体盆底肌肉活动的神经调节

• 批准号: 9790960
• 负责人: Mario Ignacio Romero-Ortega
• 金额: $ 52.94万
• 依托单位: UNIVERSITY OF TEXAS DALLAS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-24 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9790960
• 关键词: 2 year old; 4 year old; Acute; Affect; Aging; Animals; Atopobium vaginae; Axon; Birth; Bladder; Bladder Control; Caliber; Chronic; Complex; Defecation; Devices; Drug resistance; Efferent Neurons; Electric Stimulation; Electrodes; Electron Microscopy; Equipment Malfunction; Experimental Designs; Extravasation; Failure; Fatigue; Frequencies; Functional disorder; Genitourinary system; Histologic; Histology; Human; Implant; Individual; Intervention; Measurement; Measures; Methods; Modeling; Multiparity; Muscle; Muscle Fibers; Myelin; Nerve; Nerve Tissue; Nulliparity; Oryctolagus cuniculus; Pathology; Patients; Pattern; Pelvic Floor Muscle; Pelvic floor structure; Pelvis; Pharmacologic Substance; Phase; Physiological; Play; Positioning Attribute; Protocols documentation; Rectum; Recurrence; Reporting; Role; Sacral nerve; Sex Functioning; Skeletal muscle structure of perineum; Sphincter; Symptoms; Testing; Thick; Training; Ultrasonography; Urethra; Urge Incontinence; Urinary Incontinence; Urination; Urine; Urodynamics; Vagina; Vaginal delivery procedure; Wireless Technology; Woman; improved; incontinence symptom; innovation; levator ani muscle; miniaturize; muscle aging; muscle form; neuroregulation; neurotechnology; novel; pressure; sensor; side effect; simulation; treatment effect; urinary

Romero-Ortega+ ! Summary Pelvic floor muscles (PFM) form a dome-shaped muscle complex are critical in urinary continence, defecation and sexual functions, and weakening pelvic floor muscles can cause uncontrolled detrusor activity, urgency, and urinary incontinence (UI), a condition that affects 30-60% of women in the US. Recently, there is an increasing appreciation for the importance of the specific pattern of activity of antagonistic muscles in the pelvic floor, and a realization that dysfunctional timing, reduced amplitude or disorganized pattern of activity in individual muscles, critically impact their ability to maintain the urethra closed, resulting in urine leakage. Here, we hypothesize that selective and coordinated stimulation of individual PFM nerves will re-establish their normal strength and activity patterns, effectively reversing the symptoms of UI. To that end, we have established a rabbit model of UI that replicates several aspects of the human condition, including the specific pattern of activation of individual levator ani and perineal muscles during the storage and voiding phases. This proposal is innovative in that it uses a state-of-the-art miniaturized wireless electrodes to enable the interfacing of small PFM efferent nerves and directly modulate their individual activity. Our preliminary studies show that compromised micturition resulting from altered PFMs activity caused by multi-parity or aging in rabbits, can be reversed using selective PFM neuromodulation (SPNM). We specifically seek to: 1) define the activation parameters for maximal muscle force and limited fatigue for individual PFM, 2) evaluate the efficacy of patterned PFM activity by SPNM in young multiparous and aging multiparous animals, and 3) demonstrate that chronic electrical stimulation of PFM nerves can improved UI symptoms long-term, and test if that SPNM benefit persists after discontinuing the neuromodulation treatment. This proposal will provide new information on the physiological role of the PFM in urinary function, and will evaluate the selective neuromodulation of these muscles as a potential therapy for drug resistant UI.

Romero-Ortega +