Abstract
Electrical stimulation therapies to promote bladder filling and prevent incontinence deliver continuous inhibitory stimulation, even during bladder emptying. However, continuous inhibitory stimulation that increases bladder capacity (BC) can reduce the efficiency of subsequent voiding (VE). Here we demonstrate that state-dependent stimulation, with different electrical stimulation parameters delivered during filling and emptying can increase both BC and VE relative to continuous stimulation in rats and cats of both sexes. We show that continuous 10 Hz pudendal nerve stimulation increased BC (120–180% of control) but decreased VE (12–71%, relative to control). In addition to increasing BC, state-dependent stimulation in both rats and cats increased VE (280–759% relative to continuous stimulation); motor bursting in cats increased VE beyond the control (no stimulation) condition (males: 323%; females: 161%). These results suggest that a bioelectronic bladder pacemaker can treat complex voiding disorders, including both incontinence and retention, which paradoxically are often present in the same individual.
Highlights
Electrical stimulation therapies to promote bladder filling and prevent incontinence deliver continuous inhibitory stimulation, even during bladder emptying
We demonstrate the utility of differential state-dependent stimulation, to increase bladder capacity and to increase voiding efficiency in both rats and cats of both sexes
In rats and cats of both sexes the impact of state-dependent stimulation relative to continuous stimulation and no-stimulation controls was assessed based on changes in bladder capacity (BC) and VE during single-fill cystometrograms
Summary
Electrical stimulation therapies to promote bladder filling and prevent incontinence deliver continuous inhibitory stimulation, even during bladder emptying. Bladder dysfunction, including overactive bladder (OAB)—which includes urinary urgency or the sudden feeling of needing to urinate, urinary frequency, and urinary incontinence—as well as urinary retention, are highly prevalent conditions that lead to significant medical complications and decreased quality of life[1,2] For those who are not responsive to conservative therapies, second line options include β3-adrenergic agonists and anticholinergics. Strong inhibition of the bladder resulting from continuous sensory stimulation generates acute urinary retention, i.e., a substantial reduction in the efficiency of subsequent voiding[6,7,8] These observations of stimulation-induced urinary retention inspired the concept of state-dependent stimulation: use of one set of electrical stimulation parameters to promote continence during the storage phase and another set of parameters to generate efficient emptying during the voiding phase (Fig. 1). We demonstrate the utility of differential state-dependent stimulation, to increase bladder capacity (the volume the bladder can hold, BC) and to increase voiding efficiency (the proportion of fluid expelled from the bladder during voiding, VE) in both rats and cats of both sexes
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
