SCI Program

Bladder, Bowel and Sexual Function

Participants in this program utilize implanted FES systems to restore bladder and bowel function.

General Information on this clinical study

Principal Investigator: Graham Creasey, M.D.

Contact Number: 216-778-8802

Contact Email: ghc@case.edu

Program Title: Bowel, Bladder & Sexual Function

Purpose

Utilizing an implanted stimulator, this program explores restoration of bladder, bowel and sexual function individuals with spinal cord injury.

Program Description

The purpose of this project is to evaluate electrical stimulation of sensory nerves for inhibition of abnormal reflex contraction of the bladder. The long-term goal is to provide continence without the need for anticholinergic medications or surgery to cut nerve roots or augment the size of the bladder.

Electrical stimulation of sensory nerves is intended to be complementary with existing techniques for producing bladder emptying by electrical stimulation, so that a single implanted electrical stimulator could restore both micturition and continence without permanent loss of sensation or reflexes.

We have completed our research team by recruiting and hiring a Post-Doctoral Research Fellow and a Research Nurse Practitioner, and have purchased the electrical stimulators and other supplies required.

We have commenced evaluation of non-invasive electric stimulation of the dorsal penile and clitoral nerves using surface electrodes while carrying out urodynamic measurements of bladder capacity and contraction, both with conventional cystometrography and by provoking reflex contractions with small aliquots rapidly infused into the bladder, confirming that this form of electric stimulation not only reduces bladder contractions after suprasacral spinal cord injury but that it also reduces the autonomic dysreflexia often associated with such contraction. However, it appears that contraction of the external urethral sphincter is increased by the stimulation, which could interfere with electrically activated micturition, and we note a report published from Europe during the last year indicating that some patients using implanted electrical stimulators for neuromodulation without rhizotomy have experienced difficulty with electrically mediated micturition.

We therefore propose to evaluate several strategies for producing micturition when using stimulation for continence, including intermittent stimulation and the use of electrically mediated conduction block to reduce sphincter contraction, and have preliminary data indicating that such conduction block appears promising. We have found that in view of the current absence of neurosurgical support staff at the VA Medical Center, surgical implants will need to be carried out at the MetroHealth Medical Center while pre- and post-operative care, programming and follow-up of veterans can be carried out in the state-of-the-art facilities in the VA Spinal Unit.