MP08-15 HIGH-RESOLUTION EPIDURAL SPINAL CORD STIMULATION (HR-SCS) EVOKES SELECTIVE MICTURITION AND CONTINENCE REFLEXES THROUGH A FREQUENCY-DEPENDENT EFFECT GOVERNED BY DISTINCT NEURAL CIRCUITS

Abstract

You have accessJournal of UrologyBladder & Urethra: Anatomy, Physiology & Pharmacology (MP08)1 Sep 2021MP08-15 HIGH-RESOLUTION EPIDURAL SPINAL CORD STIMULATION (HR-SCS) EVOKES SELECTIVE MICTURITION AND CONTINENCE REFLEXES THROUGH A FREQUENCY-DEPENDENT EFFECT GOVERNED BY DISTINCT NEURAL CIRCUITS Chaitanya Gopinath, Maria K. Jantz, Ritesh Kumar, Bryan L. McLaughlin, and Robert A. Gaunt Chaitanya GopinathChaitanya Gopinath More articles by this author , Maria K. JantzMaria K. Jantz More articles by this author , Ritesh KumarRitesh Kumar More articles by this author , Bryan L. McLaughlinBryan L. McLaughlin More articles by this author , and Robert A. GauntRobert A. Gaunt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001981.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spinal cord stimulation (SCS) has been explored for controlling lower urinary tract function in experimental and clinical settings. However, there are no mechanistic and reproducible approaches to evoke both micturition and continence reflexes. Here, we demonstrate that epidural SCS can selectively evoke micturition and continence behaviors in both isovolumetric and cystometric studies in feline anesthetized animal model. Our results indicate the existence of two distinct frequency-dependent neural circuits mediating continence and micturition evoked by varying stimulus frequencies. METHODS: Three male and three female cats (n=6) were anesthetized with α-chloralose after initial surgical preparations under isoflurane anesthesia. Nerve cuffs were placed unilaterally on the pelvic nerve, pudendal nerve and its branches (sensory, deep perineal and caudal rectal nerves). HR-SCS electrodes (Ripple Neuro, Micro-Leads Medical) were placed on the epidural surface of sacral cord and cauda equina. Stimulation pulse trains with amplitudes between 200-800 µA were delivered through SCS electrodes while recording bladder pressure and compound action potentials in the peripheral nerve cuffs. Electromyograms from the pelvic floor and urethral sphincter, as well as bladder pressure data were collected, first under isovolumetric bladder conditions and later during filling cystometries. RESULTS: Epidural SCS through many electrodes was able to elicit functional changes in the bladder and urethra. We also identified bipolar electrode pairs that evoked a frequency-dependent effect. Stimulation at 3 Hz stimulation evoked a continence reflex, while the same electrodes evoked a voiding reflex when the stimulation frequency was changed to 33 Hz. Inhibition through 3 Hz stimulation was particularly robust and resulted in abolishing all non-voiding contractions (NVCs) and decreasing the bladder pressure to its baseline value. Voiding under 33 Hz was incomplete and varied between 20-50% of the infused volume. In 3 animals, an acute spinalization at T10 abolished all 33 Hz-evoked responses suggesting that this neural circuit requires an intact spino-bulbo-spinal reflex. The 3 Hz continence reflex remained unaffected by spinalization suggesting a local reflex in the lumbosacral spinal cord. CONCLUSIONS: HR-SCS can selectively evoke continence and micturition reflexes through a unique frequency-dependent effect. Source of Funding: NIH OT2OD024908 and Craig H. Neilsen Foundation—476681 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e155-e156 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chaitanya Gopinath More articles by this author Maria K. Jantz More articles by this author Ritesh Kumar More articles by this author Bryan L. McLaughlin More articles by this author Robert A. Gaunt More articles by this author Expand All Advertisement Loading ...