Micturitional assist device

• US 5,199,430 A
• Filed: 03/11/1991
• Issued: 04/06/1993
• Est. Priority Date: 03/11/1991
• Status: Expired due to Term

• Current Assignee: Case Western Reserve University
• Original Assignee: Case Western Reserve University
• Inventors: Mortimer, J. Thomas, Fang, Zi-Ping, Creasey, Graham H.
• Primary Examiner(s): Kamm, William E.
• Assistant Examiner(s): SCHAETZLE, KENNEDY
• Application Number:
  US07/667,523
• Time in Patent Office: 757 Days
• Field of Search: 128/419 E, 128/419 R, 128/784, 128/885, 128/386, 128/788, 128/842, 128/843
• US Class Current: 607/40
• CPC Class Codes: A61N 1/0556 Cuff electrodes
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control

Abstract

Cuff electrodes (40a, 40b) are surgically implanted around S₃ sacral ventral root nerve trunks (16a, 16b). The sacral ventral roots have smaller diameter nerve fibers (20a, 20b) which convey action potentials to cause detrusor activation to contract the bladder (10) and larger diameter nerve fibers (18a, 18 b) which carry action potentials for causing contraction of a urethral sphincter (12) to block the flow of urine from the bladder. A current source (50) causes current pulses (52) between such electrical contacts (46, 48) and a central electrical contact (44). The current pulses have an appropriate amplitude and waveform to initiate action potentials adjacent the central contact and to block the propagation of action potentials adjacent the end electrodes along the larger diameter nerve fibers (which have fewer nodes between the contacts) but not the smaller diameter nerve fibers (which have more nodes between the electrodes). In this manner, action potentials are electrically excited to propagate at least downstream on the smaller diameter nerve fibers causing contraction of the bladder. Concurrently, blocking action potentials are allowed to propagate upstream on at least the larger diameter nerve fibers, collision blocking naturally occurring action potentials propagating downstream. The transmission of action potentials downstream on the larger diameter nerve fibers is blocked by the current pulses allowing the urinary sphincter to relax.

Claims

1. A method of controlling bladder discharge in which detrusor activation for contracting the bladder is controlled by action potentials passing along smaller diameter nerve fibers of a sacral root and in which contraction of a urethral sphincter for closing an outlet from the bladder is caused by action potentials passing along larger diameter nerve fibers of the sacral root, the method of controlling bladder discharge comprising:

electrically exciting action potentials on at least the smaller diameter nerve fibers, whereby the detrusor is activated to cause contraction of the bladder;

concurrently blocking action potentials from passing along the larger diameter nerve fibers, whereby the urethral sphincter is permitted to relax.

2. The method as set forth in claim 1 wherein:

the step of exciting action potentials includes exciting action potentials on both the larger and smaller diameter nerve fibers concurrently at an excitation location; and

the blocking step includes blocking action potentials on the larger diameter nerve fibers propagating downstream from the excitation location.

3. The method as set forth in claim 2 wherein the action potential exciting step further includes:

exciting action potentials that propagate both upstream and downstream from the excitation location on both the larger and smaller diameter nerve fibers such that the excited action potentials traveling upstream collision block any naturally occurring action potentials travelling downstream from the spinal cord and those travelling downstream, from the excitation location, on the larger diameter nerve fibers are blocked at the downstream electrode.

4. The method as set forth in claim 2 further including:

implanting around the sacral root a cuff electrode which has a central electrical contact, an upstream end electrical contact upstream from the central contact, and a downstream end electrical contact downstream from the central contact toward the detrusor and the urinary sphincter;

wherein the excitation step includes applying a stimulus current pulse between the end and central electrical contacts and the blocking step includes holding the applied stimulus pulse long enough to block passage of the action potential on larger fibers at the end contacts.

5. The method as set forth in claim 4 further including selectively adjusting an amplitude of the current pulse for selectively adjusting a diameter of nerve fibers along which the propagation of action potentials is blocked.

6. The method as set forth in claim 5 further including:

implanting a second electrode on another sacral root which has larger diameter nerve fibers connected with an anal sphincter muscle and smaller diameter fibers connected with musculature for contracting a rectal canal during defecation, the second electrode having at least a second central electrical contact, a second upstream end electrical contact, and a second downstream end electrical contact;

applying an electrical current pulse between the end and central electrical contacts which excites action potentials in both the large and small diameter nerve fibers of the another sacral root and which selectively block action potentials on the larger diameter nerve fibers of the another sacral root, whereby the blocking of action potentials on the larger diameter nerve fibers causes the anal sphincter muscle to relax and action potentials passing along the smaller diameter nerve fibers cause contraction of the rectal canal.

7. The method as set forth in claim 6 further including:

implanting a third electrode on a third sacral root which controls penile erections, the third electrode including at least two electrical contacts;

selectively applying a current pulse between the two electrical contacts to induce action potentials to propagate along the third sacral root, which induced action potentials cause a penile erection.

8. A method of selectively, concurrently exciting and blocking the excitation of first and second end organs which are controlled by small and large diameter nerve fibers, respectively, of a common nerve trunk, the method comprising:

electrically exciting action potentials on at least the smaller diameter nerve fibers;

concurrently blocking action potentials from passing along the larger diameter nerve fibers toward the second end organ.

9. The method as set forth in claim 8 wherein

the step of electrically exciting action potentials includes exciting action potentials on both the larger and smaller diameter nerve fibers concurrently at an excitation location;

and

the blocking step includes blocking action potentials on only the larger diameter nerve fibers from propagating downstream from the excitation location.

10. The method as set forth in claim 9 wherein the action potential exciting step further includes exciting action potentials that propagate in both orthodromic and antidromic directions on both the large and small diameter nerve fibers such that the electrically excited action potentials travelling in the antidromic direction collision block naturally occurring action potentials travelling in the orthodromic direction on the larger diameter nerve fibers.

11. The method as set forth in claim 9 further including:

implanting a cuff electrode around the nerve trunk which electrode has a central electrical contact, an upstream end electrical contact upstream from the central contact, and a downstream end electrical contact;

wherein the excitation step includes applying a current pulse between the end contacts and central electrical contacts and the blocking step includes continuing to apply current pulse between the end contacts and central electrical contacts for a sufficient duration to hold internodes of the large diameter nerve fibers hyperpolarized until all action potentials initiated on the larger diameter nerve fibers by initially applying the current pulse are blocked.

12. The method as set forth in claim 11 further including selectively adjusting an amplitude of the current pulse for selectively adjusting a diameter of nerve fibers along which the propagation of action potentials is blocked.

13. An electrical system for selectively controlling evacuation of a patient'"'"'s bladder by concurrently generating action potentials on smaller diameter nerve fibers which cause contraction of the patient'"'"'s bladder and suppressing action potentials in larger diameter nerve fibers connected with the patient'"'"'s urethral sphincter to allow the urethral sphincter to relax, the larger and smaller diameter nerve fibers originating in part in left and right S₂ sacral roots, left and right S₃ sacral roots, and left and right S₄ sacral roots, the electrical system comprising:

a first cuff electrode at least partially encircling the left S₃ sacral root;

a second cuff electrode at least partially encircling the right S₃ sacral root;

a third cuff electrode at least partially encircling the left S₄ sacral root;

a fourth cuff electrode at least partially encircling the right S₄ sacral root;

each of the first, second, third, and fourth cuff electrodes including a central electrical contact, an antidromic end electrical contact, and an orthodromic end electrical contact, each of the cuff electrodes being implanted at least partially encircling the respective root with its antidromic end disposed closer to the patient'"'"'s spinal column than its orthodromic end;

a current source means connected between the end electrical connectors and the central electrical connector of each cuff electrode for selectively applying quasi-trapezoidal shaped current pulses have a generally flat plateau and an exponentially decaying tail;

a means for adjusting an amplitude of the current pulses such that (i) a substantially -25 millivolt potential relative to a resting potential is created across membranes of nodes of the larger and smaller diameter nerve fibers to depolarize the nodes and initiate propagation of action potentials on the larger and smaller diameter nerve fibers and (ii) a hyperpolarizing potential of about 55 millivolts more negative than the resting potential is created across the nodes of the larger diameter nerve fibers blocking orthodromic propagation of action potentials on the larger diameter fibers without blocking orthodromic action potential propagation on the smaller diameter nerve fibers.