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  4. Conditional neuromodulation of neurogenic detrusor overactivity using transrectal stimulation in patients with spinal cord injury: A proof of principle study

Conditional neuromodulation of neurogenic detrusor overactivity using transrectal stimulation in patients with spinal cord injury: A proof of principle study

Neurourology and Urodynamics, 2018 · DOI: 10.1002/nau.23310 · Published: January 1, 2018

Spinal Cord InjuryUrologyNeurology

Simple Explanation

This study tested a new device for controlling bladder problems (neurogenic detrusor over-activity) in men with spinal cord injuries. The device uses electrical stimulation through the anal canal to calm the bladder when it becomes overactive, as detected by anal sphincter muscle activity. The results showed the device increased bladder capacity and reduced bladder pressure in most participants, suggesting it could be a helpful treatment.

Study Duration
Not specified
Participants
Eight male spinal cord injured subjects
Evidence Level
Proof of principle study

Key Findings

  • 1
    Conditional neuromodulation significantly increased bladder capacity in six male subjects with spinal cord injury.
  • 2
    Conditional neuromodulation significantly reduced maximum detrusor pressure.
  • 3
    EAS activity was a reliable surrogate for detection of NDO.

Research Summary

This study investigated a novel wearable device (CARM) delivering transrectal stimulation to control neurogenic detrusor overactivity (NDO) in spinal cord injured (SCI) subjects. The device delivers conditional neuromodulation (CN) triggered by external anal sphincter (EAS) activity, increasing bladder capacity and reducing detrusor pressure. The study demonstrated that CN can be delivered and triggered via a single biocompatible device placed in the anal canal, offering a potential alternative to implanted devices.

Practical Implications

Novel Treatment Approach

The CARM device presents a new method for managing NDO in SCI patients using conditional neuromodulation.

Potential Alternative to Implants

This device could offer a less invasive alternative to implanted neuromodulation devices for some patients.

Improved Bladder Management

The device has the potential to improve bladder capacity and reduce detrusor pressure, thus protecting the upper urinary tracts and minimizing incontinence.

Study Limitations

  • 1
    Small number of subjects tested.
  • 2
    Two subjects could not tolerate the stimulation through the device.
  • 3
    Further studies are needed to assess longer-term safety and efficacy.

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