Endovascular stimulation of the pudendal nerve using a stent-mounted electrode array.

JingYang Liu, David B Grayden, Janet R Keast, Sam E John
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Abstract

Objective. Previous preclinical and clinical studies have demonstrated that pudendal nerve is a promising target for restoring bladder control. The spatial proximity between the pudendal nerve and its accompanying blood vessels in the pudendal canal provides an opportunity for endovascular neurostimulation, which is a less invasive approach compared to conventional chronically implanted electrodes. In this study, we investigated the feasibility of excitatory stimulation and kilohertz-frequency block of the compound pudendal nerve in sheep using a stent-mounted electrode array.Approach. In a set of acute animal experiments, a commercially available hexapolar electrode catheter was introduced in the unilateral internal pudendal artery to deliver bipolar electrical stimulation of the adjacent compound pudendal nerve. The catheter electrode was replaced with a custom-made stent-mounted electrode array and the stimulation sessions were repeated. Global electromyogram activity of the pelvic floor and related sphincter muscles was recorded with a monopolar electrode placed within the urethra concurrently.Main results. We demonstrated the feasibility of endovascular stimulation of the pudendal nerve with both electrode types. The threshold current of endovascular stimulation was influenced by electrode-nerve distance and electrode orientation. Increasing the axial inter-electrode distance significantly decreased threshold current. Endovascular kilohertz-frequency nerve block was possible with the electrode catheter.Significance. The present study demonstrated that endovascular stimulation of the pudendal nerve with the stent-mounted electrode array may be a promising less invasive alternative to conventional implantable electrodes, which has important clinical implications in the treatment of urinary incontinence. Endovascular blocking of pudendal nerve may provide an alternative solution to the bladder-sphincter dyssynergia problem in bladder management for people with spinal cord injury.

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使用安装在支架上的电极阵列对阴部神经进行血管内刺激。
目的:以往的临床前和临床研究表明,阴部神经是恢复膀胱控制的一个很有前景的靶点。阴部神经和其在阴部管内的伴行血管之间的空间接近性为血管内神经刺激提供了机会,与传统的慢性植入电极相比,这是一种创伤较小的方法。在这项研究中,我们利用安装在支架上的电极阵列研究了对绵羊的复发性阴部神经进行兴奋刺激和千赫兹频率阻断的可行性:在一组急性动物实验中,将市售的六极电极导管插入单侧阴茎内动脉,对邻近的复发性阴茎神经进行双极电刺激。将导管电极更换为定制的支架安装电极阵列,然后重复刺激疗程。同时记录了尿道外括约肌的整体肌电图(EMG)活动:我们证明了用两种电极类型对阴茎神经传出进行血管内刺激的可行性。血管内刺激的阈值电流受电极-神经间距和电极方向的影响。增加电极间的轴向距离可显著降低阈值电流。使用电极导管可进行血管内千赫频率神经阻滞:本研究表明,用安装在支架上的电极阵列对阴茎神经进行血管内刺激可能是一种很有前途的微创疗法,可替代传统的植入式电极,这对治疗尿失禁具有重要的临床意义。在脊髓损伤患者的膀胱管理中,血管内阻断阴部神经传出可能是解决膀胱括约肌协同障碍问题的另一种方法。
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