Neuroprosthetics for SCI Bladder Management: The Argument for Direct Bladder Stimulation
- *Corresponding Author:
- James S. Walter
VA Hines Hospital (151)
Roosevelt and First Ave, Hines, IL 60141, USA
Tel: 708 202-5805
E-mail: [email protected]
Received June 27, 2014; Accepted September 20, 2014; Published September 25, 2014
Citation: Walter JS, Wheeler J, Bresler L, Sayers S, Singh S (2014) Neuroprosthetics for SCI Bladder Management: The Argument for Direct Bladder Stimulation. Int J Phys Med Rehabil 2:230. doi: 10.4172/2329-9096.1000230
Copyright: © 2014 Walter JS, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Implantable neuroprosthetic systems are an important area of practice and research in urinary care for individuals with spinal cord injury (SCI). These devices need to manage three lower urinary tract conditions: urethral sphincter contractions during bladder contractions, an underactive bladder producing poor voiding responses, and neurogenic detrusor overactivity causing urinary incontinence. Two neuroprosthetic approaches have addressed these conditions: sacral anterior root stimulation (SARS) and direct bladder wall stimulation (DBWS). The SARS approach is commercialized for SCI bladder management as the Brindley-Finetech Bladder Control System and is available in Europe. Limitations of this device include invasive surgery and the need for rhizotomy of sacral dorsal (sensory) nerve roots. The DBWS implants produced daily voiding in many SCI individuals, however, clinical use was discontinued primarily because of technical concerns with stimulators and electrodes as well as some cases of poor voiding responses and side effects. These limitations are reviewed as well as efforts to return DBWS to clinical investigations using Permaloc® Systems (Synapse Biomedical Inc., Oberlin OH). This new neuroprosthetic platform includes mapping and intramuscular electrodes as well as multilead cables and new stimulator devices.