Method and system for controlling bladder evacuation

• US 4,607,639 A
• Filed: 05/18/1984
• Issued: 08/26/1986
• Est. Priority Date: 05/18/1984
• Status: Expired due to Term

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Lue, Tom F., Schmidt, Richard A., Tanagho, Emil A., Gleason, Curtis A.
• Primary Examiner(s): Kamm, William E.
• Application Number:
  US06/611,836
• Time in Patent Office: 830 Days
• Field of Search: 128/419 E, 128/784, 128/785
• US Class Current: 607/40
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control

Abstract

A method for controlling the function of a bladder, includes identification of the anatomical location of at least one nerve controlling the muscles for the bladder and/or its sphincter and positioning of an electrode on the nerve to selectively stimulate the nerve for continence and evacuation purposes. The electrode can be implanted in a patient either surgically or percutaneously and may be either removed after proper stimulation has achieved the desired result (neurostimulation) or may be left intact on the nerve for selective stimulation thereof. An electronic control system is disclosed for electrically energizing two or more implanted electrodes in a preselected timed relationship.

Claims

1. A method for simultaneously controlling the coordinated and synchronized functions of a bladder and associated external sphincter in an anatomical system of a selected human, said system including S2, S3 and S4 sacral segments of a spinal cord and a sacral nerve originating at each of said sacral segments and each of said sacral nerves including a dorsal root and a ventral root in a sacral canal, said sacral nerves forming a pelvic nerve when they leave the sacral canal connected to said bladder to control contractions of a detrusor muscle thereof, a superior somatic nerve and an inferior somatic nerve connected to muscles controlling the external sphincter of said bladder, said method comprising the steps of

identifying the anatomical location and functional characteristics of those nerve fibers controlling the separate functions of said bladder and external sphincter,

separating motor, sensory and autonomic and somatic nerve fibres controlling the separate functions of the bladder and associated external sphincter from other nerve fibers,

positioning electrode means on selected ones of said nerve fibers for electrically stimulating such fibers while simultaneously isolating adjacent nerve fibers therefrom, and

applying coordinated and synchronized pulse trains sequentially or simultaneously to said electrode means to simultaneously and/or separately control the functions of said bladder and external sphincter.

2. The method of claim 1 wherein said identifying step comprises the step of percutaneously inserting a nerve stimulator in at least close proximity to said nerve and recording said response to stimulation of said nerve urodynamically.

3. The method of claim 2 wherein said inserting step comprises inserting said nerve stimulator through the dorum and sacral foramen of at least one of said S2, S3 and S4 sacral segments of a spinal cord and sacrum.

4. The method of claim 1 wherein said identifying step comprises identifying said S3 sacral nerve and further comprising separating the dorsal and ventral roots of said S3 sacral nerve, said positioning step comprising attaching at least one electrode on said ventral root in the sacral canal.

5. The method of claim 4 further comprising the step of sectioning said superior somatic nerve to isolate levator ani muscles at least partially surrounding said external sphincter.

6. The method of claim 5 wherein said attaching step comprises attaching a pair of electrodes bilaterally on said S3 sacral nerve and said sectioning step comprises bilaterally sectioning said superior somatic nerve.

7. The method of claim 1 further comprising the steps of sectioning said superior somatic nerve to at least unilaterally isolate said external sphincter, identifying and separating the dorsal and ventral roots of said S3 sacral nerve, and sectioning said dorsal root, said positioning step comprising attaching an electrode on said S3 sacral nerve.

8. The method of claim 7 further comprising the steps of sectioning said S3 sacral nerve, between said pelvic and inferior somatic nerves, sectioning said superior somatic nerve, identifying and separating said S2 sacral nerve into dorsal and ventral roots, sectioning said S2 dorsal root and attaching an electrode to said S2 ventral root.

9. The method of claim 8 further comprising the step of attaching an electrode to the opposite side of said S3 sacral nerve, opposite to the side whereat said previously mentioned electrode is attached thereto, upstream of the point whereat said pelvic nerve is formed.

10. The method of claim 8 further comprising the step of attaching an electrode to said S4 sacral nerve.

11. The method of claim 1 wherein said identifying step comprises identifying each of said S3 and S4 sacral nerves and said positioning and confining step comprises percutaneously implanting an electrode on at least one of said S3 and S4 sacral nerves.

12. The method of claim 11 further comprising percutaneously implanting an electrode on each of said S3 and S4 sacral nerves.

13. The method of claim 11 further comprising at least unilaterally sectioning said superior somatic nerve.

14. The method of claim 1 wherein said identifying step comprises electrostimulating at least one of said S2, S3 and S4 sacral nerves and recording results therefrom urodynamically.

15. The method of claim 14 wherein said positioning step comprises percutaneously implanting at least one electrode on at least one of said S2, S3 and S4 sacral nerves in accordance with said recording step.

16. The method of claim 1 wherein said identifying step comprises identifying each of said superior and inferior somatic nerves and said positioning step comprises attaching at least one electrode to said inferior somatic nerve and further comprising the step of sectioning said superior somatic nerve.

17. The method of claim 16 wherein said attaching step comprises attaching a pair of said electrodes bilaterally on said inferior somatic nerve and said sectioning step comprises sectioning said superior somatic nerve bilaterally.

18. The method of claim 1 wherein said identifying step comprises identifying said S3 sacral nerve and said inferior somatic nerve and said positioning step comprises attaching at least one electrode on said inferior somatic nerve and attaching at least one electrode on said S3 sacral nerve, between said sacral segment S3 and said pelvic nerve.

19. The method of claim 18 wherein said attaching steps comprise attaching a pair of electrodes to said inferior somatic nerve bilaterally and attaching a pair of electrodes to said S3 sacral nerve bilaterally.

20. The method of claim 1 wherein said identifying step comprises identifying each of said superior and inferior somatic nerves and said positioning step comprises attaching at least one electrode to each of said superior and inferior somatic nerves.

21. The method of claim 20 further comprising the step of bilaterally attaching a pair of electrodes on each of said superior and inferior somatic nerves.

22. The method of claim 1 wherein said identifying step comprises identifying each of said S3 sacral nerve and said inferior somatic nerve and further comprising separating the dorsal and ventral roots of said S3 sacral nerve at least unilaterally and said positioning step comprises attaching at least one electrode to each of said inferior somatic nerve and said S3 ventral root.

23. The method of claim 22 comprising bilaterally attaching a pair of electrodes to each of said inferior somatic nerve and to said S3 ventral roots.

24. The method of claim 22 further comprising sectioning said superior somatic nerve.

25. The method of claim 1 wherein said identifying step comprises identifying said S3 sacral nerve and each of said superior and inferior somatic nerves and wherein said positioning step comprises attaching an electrode to each of said inferior somatic and S3 sacral nerves.

26. The method of claim 25 further comprising separating the dorsal and ventral roots of said S3 sacral nerve and attaching said electrode to said S3 ventral root.

27. The method of claim 25 further comprising percutaneously attaching a second electrode to said S3 sacral nerve on an opposite side from said first-mentioned electrode attached thereto.

28. The method of claim 25 further comprising attaching an electrode on said S4 sacral nerve.

29. The method of claim 25 further comprising attaching an electrode on said superior somatic nerve.

30. The method of claim 1 wherein said identifying step comprises identifying each of said superior somatic nerve and said inferior somatic nerve and further comprising sectioning said superior somatic nerve and wherein said positioning step comprises attaching at least one electrode to said inferior somatic nerve.

31. The method of claim 30 further comprising sectioning said inferior somatic nerve.

32. The method of claim 1 wherein said positioning step comprises attaching at least one first electrode means to a first one of said nerve fibers and attaching at least one second electrode means to a second one of said nerve fibers and further comprising implanting at least one pair of subcutaneous first and second receivers on said human, electrically connecting said first and second electrode means to said first and second receivers, respectively, and said applying step comprises energizing said receivers with electrical pulse trains in timed relationship relative to each other.

33. The method of claim 32 wherein said first electrode means comprise a first pair of electrodes and said second electrode means comprises a second pair of electrodes and further comprising continuously controlling transmission of electrical pulses to said first pair of electrodes, interrupting transmission of electrical pulses to said first pair of electrodes and simultaneously transmitting electrical pulses to said second pair of electrodes.