Thanks for having me here. I’ve been asked to talk, but I’m here to listen. This is a brilliant conference, and we’ll be taking a lot of these lessons back to our own meetings. A lot of what we hear from you does go back to our meetings.
I’m going to present some data from our lab, and I need to start by acknowledging that this is a big team effort.
Let’s start with a primer about how a healthy bladder works. You have a bladder that’s like a balloon filling slowly with water. When you want to empty it, you send a signal to the muscles at the bottom of it to relax.
What happens after an injury is that you get a reflex contraction … you can’t control this (it’s like any other reflex; it happens without your authorization), which is what causes the need to cath.
It’s been 14 years since Kim Anderson gave us the survey data that named bladder function as a top priority. We spent from January to June of 2018 launching a survey of our own, and got over 500 responses.
We asked people to rank their choices … the top 3 are no catheters, no leaking, no complications.
So we asked how they’d feel about using nerve stimulation as a possible solution. People are more willing to accept the idea of a neuromodulation approach … which is reassuring to me and people like me, because there’d be no point in doing this work if we knew nobody would want it.
We’re trying to set up a framework that gets the community where it wants to go.
Where would we stick electrodes? Acute genital nerve stimulation strongly inhibits bladder contractions … (translation: if you put an electrode on the top of the penis on the pudendal nerve, you can use it to very reliably control bladder function.)
Yowl. So for people with sensation, the reaction is something like “You’re putting a stimulator where??” But it turns out that surface stimulation on that nerve is very well-tolerated. Most of the patients could tolerate it at higher levels than we needed. So we sent people home with these things and had them record what happened. What we learned is that it worked, they liked it, and they wanted to keep using it.
How does this get better? The subjects did NOT like the stimulator design. It was bulky. It had long wires. They were tethered to the on-demand control.
Could we implant it somehow? There’s something called the Finetech-Brindley system, still available in Europe but not in the US. It was implanted … it did restore function but it had limitations, like it required surgery and it required cutting sensory nerves, permanently.
We wondered if, instead of cutting nerves, we could just do a temporary nerve block, like you get at the dentist. They’ve done animal studies to understand better how this might work & are getting ready to approach the FDA.
Back to bowel. Two big asks — reduce incontinence and make the routine faster. I’ve helped people with their bowel routine. I get it. There were experiments done back in the 60s and 70s (with cats) that involved a balloon catheter. They’re working with animals now on ways to electrically stimulate the bowel so that it can be controlled.
(Okay, that went by really fast but I need to say that this is the very first time a scientist has ever mentioned that he personally helped a patient with his bowel program. The research world might change permanently if even half of them engaged with us just one time on that level. Hats off to Dennis.)