CH507005A - Device for electrical neurostimulation for the evacuation of the neurogenic urinary bladder - Google Patents
Device for electrical neurostimulation for the evacuation of the neurogenic urinary bladderInfo
- Publication number
- CH507005A CH507005A CH429569A CH429569A CH507005A CH 507005 A CH507005 A CH 507005A CH 429569 A CH429569 A CH 429569A CH 429569 A CH429569 A CH 429569A CH 507005 A CH507005 A CH 507005A
- Authority
- CH
- Switzerland
- Prior art keywords
- polyethylene
- bladder
- organism
- sheet
- electrodes
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/372—Arrangements in connection with the implantation of stimulators
- A61N1/378—Electrical supply
- A61N1/3787—Electrical supply from an external energy source
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
- A61F2/0031—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
- A61F2/0036—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/36007—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of urogenital or gastrointestinal organs, e.g. for incontinence control
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/0551—Spinal or peripheral nerve electrodes
Description
Appareil pour la neurostimulation électrique en vue de l'évacuation de la vessie urinaire neurogène
L'invention a pour objet un appareil pour la neurostimulation électrique en vue de l'évacuation de la vessie urinaire neurogène, par exemple après les traumatismes de la moelle épinière ainsi que dans d'autres affections du système nerveux.
On connaît diverses méthodes de traitement de la rétention d'urine comme conséquence des traumatismes médullaires ou d'autres affections du système nerveux:
Le drainage intermittent par le cathétérisme uréthral qui présente, d'une part, le désavantage de l'infection urinaire avec ses complications (lithiase, pyélonéphrite, urémie) et d'autre part, l'impossibilité d'être appliqué dans tous les cas (strictures uréthrales, ruptures de l'urèthre, etc.).
Le drainage permanent à sonde uréthrale qui représente un danger plus grand d'infection ainsi que la modification du tissu musculaire et élastique de la vessie, urémie, etc.
La cystostomie, presque abandonnée, qui en dehors du danger d'infection, retarde la récupération des contractions vésicales reflexes et présente une grande incommodité pour le malade.
I1 y a aussi une méthode de stimulation électrique directe du muscle vésical qui consiste à stimuler celui-ci à l'aide d'électrodes en fils d'acier ou sous forme de disques, fixés sur la paroi de la vessie, électrodes qui sont liées à un récepteur, introduit par voie chirurgicale sous la peau, et qui est mis en fonction, par un émetteur externe à puissance réduite de pénétration.
A cause d'une tension électromotrice induite élevée, jusqu'à 40 volts, cette méthode a le désavantage de produire une douleur pendant la stimulation, des contractions de la musculature des membres inférieurs et de l'abdomen, des brûlures et cicatrices au niveau de la stimulation, la perforation de la paroi vésicale et l'interruption des conducteurs par les mouvements, inconvénients qui contre-indiquent ou limitent les possibilités de son application.
On a donc cherché un appareil qui supprime les désavantages décrits ci-dessus en évitant le cathétérisme, les complications infectieuses et les inconvénients résultant de l'application du stimulus électrique sur le muscle vésical, et qui utilise la stimulation électrique des nerfs moteurs vésicaux chez l'homme.
Cet appareil est caractérisé en ce qu'il comprend un dispositif émetteur comprenant un oscillateur de signaux à la fréquence de 300 kHz, un générateur d'impulsions rectangulaires de 5 à 10mA, de 15 à 20Hz et d'une durée de 7ms, un modulateur du signal émis par l'oscillateur à la cadence des impulsions rectangulaires produites par le générateur, et un amplificateur de puissance qui amplifie le signal reçu du modulateur et le transmet ensuite à un circuit accordé, couplé par induction à une antenne extérieure produisant un champ électromagnétique à grande puissance de pénétration dans l'organisme et un récepteur isolé dans une matière plastique bien tolérée par l'organisme,
destiné à être introduit par voie chirurgicale sur la paroi antérieure du sacrum et constitué par un circuit accordé sur la fréquence du dispositif émetteur et dont le circuit secondaire est formé d'un détecteur à diode de germanium, le courant étant filtré ensuite par un condensateur et appliqué aux bornes de deux électrodes fixées sur les nerfs moteurs de la vessie urinaire.
Le dessin annexé représente, à titre d'exemple, une forme d'exécution de l'appareil selon l'invention:
La fig. 1 est le schéma-bloc de cette forme d'exécution;
la fig. 2 est le schéma de détail d'un inducteur et d'un récepteur que comprend cette forme d'exécution;
la fig. 3 illustre l'emplacement dans l'organisme du récepteur et des électrodes;
la fig. 4 est une vue schématique des électrodes et de leur emplacement sur le nerf érecteur, et
la fig. 5 illustre le pliage de l'électrode sur le nerf érecteur.
L'appareil représenté comprend un émetteur d'ondes électromagnétiques, constitué par un générateur G qui produit des impulsions électriques rectangulaires ayant les caractéristiques suivantes: 5 à 10 mA, 15 à 20 impulsions par seconde d'une durée de 7 ms.
Le générateur G module, à l'aide d'un modulateur M, un courant électrique à fréquence de 300 kHz, produit par un oscillateur O. Après amplification par un amplificateur P, le courant électrique arrive à un inducteur I dont le circuit oscillant produit, par une antenne extérieure A, un champ électromagnétique H à grande puissance de pénétration dans l'organisme.
Le champ électromagnétique H influence un récepteur R fixé au préalable sur la paroi antérieure du sacrum. Ce récepteur est constitué par un circuit oscillant LC1 accordé sur la fréquence de l'inducteur extérieur, dont le circuit secondaire alimente un détecteur D à diode de germanium, le courant étant ensuite filtré à l'aide d'un condensateur C; et appliqué aux bornes de deux électrodes E.
Pour utiliser l'appareil décrit, on dénude des nerfs érecteurs 1 (fig. 3), sur lesquels on applique les électrodes bipolaires 2, constituées par une feuille flexible 3 de polyéthylène tolérée par l'organisme, deux fils de platine 5 placés à distance l'un de l'autre sur la feuille de polyéthylène. une première pièce 4 de polyéthylène fixée à une extrémité de la feuille 3 pour couvrir les deux fils de platine, et une seconde pièce 4' de polyéthylène fixée à l'autre extrémité de la feuille 3 pour couvrir les deux fils de platine, les deux pièces laissant la zone centrale de ces fils libre pour le contact intime avec la surface des nerfs après pliage des électrodes (fig. 4). Une fois pliées, les électrodes sont fixées par deux points de suture.
Le récepteur avec les deux électrodes reste définitivement inclus dans l'organisme. Il n'entre en fonctionnement qu'à l'approche de l'antenne de l'appareil émetteur de la zone où le récepteur est inclus. Les stimulations électriques provenant du récepteur et transmises aux nerfs moteurs de la vessie urinaire V par l'intermédiaire des électrodes produisent la contraction de la vessie et l'évacuation de l'urine.
On reproduit ci-dessous une série de cas cliniques.
auxquels on a appliqué la neurostimulation électrique des nerfs érecteurs à l'aide de l'appareil décrit, dans des cas de fracture de la colonne vertébrale.
Cas I - Malade avec fracture accidentelle de la colonne vertébrale au niveau des Xe et XIe vertèbres dorsales. Drainage par sonde à demeure pour paraplégie avec rétention d'urine. 3 semaines après l'accident, on applique, par voie chirurgicale, le récepteur pour la neurostimulation de la vessie, en retirant la sonde. On pratique l'évacuation artificielle de la vessie par neurostimulation. L'urine devient stérile et la vessie se vide sans résidu.
Cas 2 - Traumatisme avec fracture au niveau de la VIIIe vertèbre dorsale. Drainage par sonde à demeure et infection urinaire consécutive. 4 semaines après on retire la sonde et la rétention urinaire persiste. On applique l'évacuation artificielle de la vessie par neurostimulation électrique. L'urine devient claire et stérile.
Cas 3 - Infection urinaire par catéthérisme due à la sonde à demeure chez un malade avec traumatisme vertébral et section médullaire au niveau de la VIe vertèbre dorsale.
Application du récepteur et neurostimulation avec évacuation vésicale complète; les urines deviennent claires et stériles.
Device for electrical neurostimulation for the evacuation of the neurogenic urinary bladder
The invention relates to an apparatus for electrical neurostimulation for the evacuation of the neurogenic urinary bladder, for example after trauma to the spinal cord as well as in other disorders of the nervous system.
Various methods of treating urine retention as a result of spinal cord injuries or other nervous system disorders are known:
Intermittent drainage by urethral catheterization which presents, on the one hand, the disadvantage of urinary tract infection with its complications (lithiasis, pyelonephritis, uremia) and on the other hand, the impossibility of being applied in all cases ( urethral strictures, ruptures of the urethra, etc.).
Permanent drainage by urethral catheter which represents a greater danger of infection as well as modification of the muscular and elastic tissue of the bladder, uremia, etc.
The cystostomy, almost abandoned, which apart from the danger of infection, delays the recovery of the reflex bladder contractions and presents a great inconvenience for the patient.
There is also a method of direct electrical stimulation of the bladder muscle which consists of stimulating it using electrodes made of steel wires or in the form of discs, fixed to the wall of the bladder, electrodes which are linked to a receiver, inserted by surgery under the skin, and which is activated, by an external transmitter with reduced penetrating power.
Due to a high induced electromotive voltage, up to 40 volts, this method has the disadvantage of producing pain during stimulation, contractions of the musculature of the lower limbs and abdomen, burns and scars in the area. stimulation, perforation of the bladder wall and interruption of conductors by movement, drawbacks which contraindicate or limit the possibilities of its application.
An apparatus has therefore been sought which overcomes the disadvantages described above by avoiding catheterization, the infectious complications and the disadvantages resulting from the application of the electrical stimulus to the bladder muscle, and which uses the electrical stimulation of the bladder motor nerves in the bladder. 'man.
This apparatus is characterized in that it comprises a transmitter device comprising a signal oscillator at the frequency of 300 kHz, a generator of rectangular pulses of 5 to 10mA, of 15 to 20Hz and of a duration of 7ms, a modulator of the signal emitted by the oscillator at the rate of the rectangular pulses produced by the generator, and a power amplifier which amplifies the signal received from the modulator and then transmits it to a tuned circuit, inductively coupled to an external antenna producing an electromagnetic field with high penetrating power in the organism and an isolated receptor in a plastic material well tolerated by the organism,
intended to be introduced by surgery on the anterior wall of the sacrum and constituted by a circuit tuned to the frequency of the emitting device and whose secondary circuit is formed of a germanium diode detector, the current then being filtered by a capacitor and applied to the terminals of two electrodes attached to the motor nerves of the urinary bladder.
The appended drawing represents, by way of example, an embodiment of the apparatus according to the invention:
Fig. 1 is the block diagram of this embodiment;
fig. 2 is the detailed diagram of an inductor and a receiver included in this embodiment;
fig. 3 illustrates the location in the body of the receptor and the electrodes;
fig. 4 is a schematic view of the electrodes and their location on the erector nerve, and
fig. 5 illustrates the folding of the electrode over the erector nerve.
The apparatus shown comprises an emitter of electromagnetic waves, constituted by a generator G which produces rectangular electrical pulses having the following characteristics: 5 to 10 mA, 15 to 20 pulses per second with a duration of 7 ms.
The generator G modulates, using a modulator M, an electric current at a frequency of 300 kHz, produced by an oscillator O. After amplification by an amplifier P, the electric current arrives at an inductor I whose oscillating circuit produces , by an external antenna A, an electromagnetic field H with great penetrating power in the organism.
The electromagnetic field H influences an R receptor fixed beforehand on the anterior wall of the sacrum. This receiver consists of an oscillating circuit LC1 tuned to the frequency of the external inductor, the secondary circuit of which supplies a detector D with a germanium diode, the current then being filtered using a capacitor C; and applied to the terminals of two electrodes E.
To use the apparatus described, erector nerves 1 are exposed (fig. 3), on which the bipolar electrodes 2 are applied, consisting of a flexible sheet 3 of polyethylene tolerated by the organism, two platinum wires 5 placed at a distance each other on the polyethylene sheet. a first piece 4 of polyethylene attached to one end of sheet 3 to cover the two platinum wires, and a second piece 4 'of polyethylene attached to the other end of sheet 3 to cover the two platinum wires, both pieces leaving the central area of these wires free for intimate contact with the surface of the nerves after bending the electrodes (fig. 4). Once folded, the electrodes are secured with two stitches.
The receptor with the two electrodes remains permanently included in the organism. It only comes into operation when the antenna of the transmitting device is near the area where the receiver is included. The electrical stimuli from the receptor and transmitted to the motor nerves of the urinary bladder V through the electrodes cause the bladder to contract and the urine to pass.
A series of clinical cases is reproduced below.
to which the electrical neurostimulation of the erector nerves with the aid of the apparatus described has been applied in cases of fracture of the spine.
Case I - Patient with accidental fracture of the spine at the level of the 10th and 11th dorsal vertebrae. Indwelling catheter drainage for paraplegia with urine retention. 3 weeks after the accident, the receptor for neurostimulation of the bladder is applied surgically, removing the probe. Artificial evacuation of the bladder is performed by neurostimulation. The urine becomes sterile and the bladder empties without residue.
Case 2 - Trauma with fracture at the level of the 8th dorsal vertebra. Indwelling catheter drainage and subsequent urinary tract infection. 4 weeks later, the catheter is removed and urinary retention persists. Artificial evacuation of the bladder is applied by electrical neurostimulation. The urine becomes clear and sterile.
Case 3 - Urinary infection by catetherism due to the indwelling catheter in a patient with vertebral trauma and medullary section at the level of the 6th dorsal vertebra.
Receptor application and neurostimulation with complete bladder evacuation; urine becomes clear and sterile.
Claims (1)
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE19691915486 DE1915486A1 (en) | 1969-03-26 | 1969-03-26 | Electronic urinary catheter |
Publications (1)
Publication Number | Publication Date |
---|---|
CH507005A true CH507005A (en) | 1971-05-15 |
Family
ID=5729398
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CH429569A CH507005A (en) | 1969-03-26 | 1969-03-21 | Device for electrical neurostimulation for the evacuation of the neurogenic urinary bladder |
Country Status (5)
Country | Link |
---|---|
US (1) | US3650276A (en) |
CH (1) | CH507005A (en) |
DE (1) | DE1915486A1 (en) |
FR (1) | FR2038813A5 (en) |
NL (1) | NL6905627A (en) |
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US8929991B2 (en) | 2005-10-19 | 2015-01-06 | Advanced Neuromodulation Systems, Inc. | Methods for establishing parameters for neural stimulation, including via performance of working memory tasks, and associated kits |
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US20070265675A1 (en) * | 2006-05-09 | 2007-11-15 | Ams Research Corporation | Testing Efficacy of Therapeutic Mechanical or Electrical Nerve or Muscle Stimulation |
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US8160710B2 (en) * | 2006-07-10 | 2012-04-17 | Ams Research Corporation | Systems and methods for implanting tissue stimulation electrodes in the pelvic region |
US20090012592A1 (en) * | 2006-07-10 | 2009-01-08 | Ams Research Corporation | Tissue anchor |
US20080249591A1 (en) * | 2007-04-06 | 2008-10-09 | Northstar Neuroscience, Inc. | Controllers for implantable medical devices, and associated methods |
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US9427573B2 (en) | 2007-07-10 | 2016-08-30 | Astora Women's Health, Llc | Deployable electrode lead anchor |
US20090254144A1 (en) | 2008-04-02 | 2009-10-08 | Case Western Reserve University | System and Method of Bladder and Sphincter Control |
US20100217340A1 (en) * | 2009-02-23 | 2010-08-26 | Ams Research Corporation | Implantable Medical Device Connector System |
US9539433B1 (en) | 2009-03-18 | 2017-01-10 | Astora Women's Health, Llc | Electrode implantation in a pelvic floor muscular structure |
US8380312B2 (en) * | 2009-12-31 | 2013-02-19 | Ams Research Corporation | Multi-zone stimulation implant system and method |
US9220887B2 (en) | 2011-06-09 | 2015-12-29 | Astora Women's Health LLC | Electrode lead including a deployable tissue anchor |
US9731112B2 (en) | 2011-09-08 | 2017-08-15 | Paul J. Gindele | Implantable electrode assembly |
US9314629B2 (en) * | 2011-10-13 | 2016-04-19 | Marc Possover | Method for recovering body functions |
US9364667B1 (en) | 2014-03-31 | 2016-06-14 | Elassia LLC | Potentiating or eliciting an erotic sensation in a body using electrostimulation |
Family Cites Families (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US3421511A (en) * | 1965-12-10 | 1969-01-14 | Medtronic Inc | Implantable electrode for nerve stimulation |
-
1969
- 1969-03-21 CH CH429569A patent/CH507005A/en not_active IP Right Cessation
- 1969-03-25 US US810167A patent/US3650276A/en not_active Expired - Lifetime
- 1969-03-26 DE DE19691915486 patent/DE1915486A1/en not_active Ceased
- 1969-03-31 FR FR6909561A patent/FR2038813A5/fr not_active Expired
- 1969-04-11 NL NL6905627A patent/NL6905627A/en not_active Application Discontinuation
Also Published As
Publication number | Publication date |
---|---|
FR2038813A5 (en) | 1971-01-08 |
US3650276A (en) | 1972-03-21 |
NL6905627A (en) | 1970-10-13 |
DE1915486A1 (en) | 1970-10-08 |
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