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Epidural Spinal Cord Stimulation for Lower Urinary Tract Control

Jantz, Maria (2024) Epidural Spinal Cord Stimulation for Lower Urinary Tract Control. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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When imagining a spinal cord injury (SCI), people often focus on the most visible consequences, such as impaired arm and leg movements. However, one of the most limiting yet often overlooked effects of spinal cord injury is lower urinary tract (LUT) dysfunction. Nearly all people with SCIs lose voluntary control of their bladders, which has serious physical and mental health consequences. Unfortunately, existing interventions to treat LUT dysfunction only manage symptoms, rather than restoring bladder function, and are frequently accompanied by dangerous side effects.

In this thesis, we investigated a novel approach to restoring bladder function by using epidural spinal cord stimulation (SCS). Fully restored bladder control requires both voiding (expelling urine) and continence (storing urine). After SCI, spinal reflexes that evoke both components of LUT function remain intact, but they are uncoordinated due to the loss of descending control. It is possible to activate reflex pathways by using SCS to evoke activity in sensory neurons. This method has recently been used to modulate locomotion, grasp, and autonomic function, but its use for bladder function has been minimally explored. We hypothesized that by applying SCS to the sacral spinal cord, where much of the LUT innervation arises, LUT neurons could be recruited to drive reflexive bladder function.

We found that sacral SCS in cats can be used to selectively recruit the pelvic and pudendal nerves that innervate the LUT. We then explored the use of SCS to activate the pudendo-vesical reflex, which has a stimulation-frequency-dependent effect that can evoke both voiding and continence. Using a novel computational model of the sacral spinal cord, we determined that sacral SCS preferentially recruits the afferent activity necessary to activate this reflex and identified the relative functional contributions of the pelvic and pudendal afferents. Finally, using sacral SCS, we evoked both voiding and continence in anesthetized cats and evaluated clinical metrics of effective bladder control. Together, these studies suggest that SCS could be used clinically to restore bladder function after SCI.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Jantz, Mariamkj8@pitt.edumkj80000-0002-4623-7690
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorGaunt, Robert Arag53@pitt.edurag530000-0001-6202-5818
Committee MemberFisher, Lee Elef44@pitt.edulef440000-0002-9072-3119
Committee MemberCapogrosso, Marcomcapo@pitt.edumcapo0000-0002-0975-316X
Committee MemberPirondini, Elviraelvirap@pitt.eduelvirap0000-0002-8078-3951
Committee MemberBoninger, Michaelboninger@pitt.eduboninger0000-0001-6966-919X
Committee MemberGrill, Warrenwarren.grill@duke.edu0000-0001-5240-6588
Date: 11 January 2024
Date Type: Publication
Defense Date: 8 September 2023
Approval Date: 11 January 2024
Submission Date: 28 September 2023
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 198
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Bioengineering
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Bladder function, spinal cord injury, neuromodulation, electrophysiology, sensorimotor, micturition
Date Deposited: 11 Jan 2024 19:27
Last Modified: 11 Jan 2024 19:27


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