Impact of Bioelectronic Medicine on the Neural Regulation of Pelvic Visceral Function

Abstract

Neuromodulation elicited by electrical stimulation of peripheral or spinal nerves is a U.S. Food and Drug Administered (FDA)-approved therapy for treating disorders of the pelvic viscera, including urinary urgency, urgency-frequency, nonobstructive urinary retention and fecal incontinence. The technique is also being tested experimentally for its efficacy in treating interstitial cystitis, chronic constipation and pelvic pain. The goal of neuromodulation is to suppress abnormal visceral sensations and involuntary reflexes and restore voluntary control. Although detailed mechanisms underlying the effects of neuromodulation are still to be elucidated, it is generally believed that effects are due to stimulation of action potentials in somatic afferent nerves. Afferent nerves project to the lumbosacral spinal cord, where they release excitatory neurotransmitters that activate ascending pathways to the brain or spinal circuits that modulate visceral sensory and involuntary motor mechanisms. Studies in animals revealed that different types of neuromodulation (for example, stimulation of a sacral spinal root, pudendal nerve or posterior tibial nerve) act by releasing different inhibitory and excitatory neurotransmitters in the central nervous system. In addition, certain types of neuromodulation inhibit visceral smooth muscle by initiating reflex firing in peripheral autonomic nerves or excite striated sphincter muscles by initiating reflex firing in somatic efferent nerves. This report will provide a brief summary of (a) neural control of the lower urinary tract and distal bowel, (b) clinical use of neuromodulation in the treatment of bladder and bowel dysfunctions, (c) putative mechanisms of action of neuromodulation on the basis of animal experiments and (d) new approaches using combination therapies to improve the efficacy of neuromodulation.

Electrical stimulation structurally affects the tissues of the rectum and anus of nulliparous rats

“…; Vonthein et al. ; de Groat & Tai, ). Considering these approaches, how ARES structurally affects the tissues must be clarified.…”

Influence of urothelial or suburothelial cholinergic receptors on bladder reflexes in chronic spinal cord injured cats

“…This experimental design may have contributed to the gradual long-term changes in CMG parameters noted in most animals. Despite these deficiencies, the animal model developed in this study which utilized weekly/biweekly urethral catheterization in place of indwelling catheters to monitor bladder function in conscious animals should be useful for examining the efficacy of long-term drug treatments, neuromodulation (de Groat and Tai, 2015), intraspinal therapies (Lee et al, 2013), or peripheral nerve re-routing (Gomez-Amaya et al, 2015) in reversing bladder dysfunction after SCI in a non-rodent, larger animal model.…”

Neuromodulation of pelvic nerve during early phase of spinal cord injury in rats using implantable prototype devices - a preliminary study

“…Bladder size, capacity, and preservation of nonvoiding spontaneous contractions 18 were monitored and quantified. As the pelvic nerve also carries sensory afferents that convey information from mechanoreceptors and nociceptors within the bladder wall 1 , we also performed extraneural recordings from pelvic nerve using both commercial benchtop system as well as implantable neural amplifier to examine the possibility of using pelvic nerve signals as a proxy to estimate intravesical pressure changes for closed-loop applications 19 .…”