Investigation of the Feasibility of Functional Electrical Stimulation in the Treatment of Bladder Dysfunction under a Diabetic Rat Model

In Taiwan, diabetic mellitus (DM) is a high prevalent disorder among people, which strictly threatens to everyone’s healthy condition. Severe DM may induce other complicated complications, such as retinal pathology, cardiovascular disease, chronic renal failure, and bladder voiding dysfunction etc. The bladder function disorder, i.e. diabetic cystopathy, is associated with the impairment of the nerve system in lower urinary tract (LUT). However, its detailed electroneurophysiological mechanisms remain controversial. In clinical treatment, patients with diabetic bladder dysfunction are usually refractory to conventional medications. To these patients, functional electrical stimulation (FES) may be a newly alternative treatment approach for curing their bladder dysfunctions. Currently, the VOCARE bladder control system has been approved for the use in spinal cord injured (SCI) patients by FDA. However, the VOCARE system is not suitable for the application in diabetic patient since the neuropathological mechanisms of bladder dysfunction differ from those in neurogenic bladder. Therefore, it is essential to develop a specifically functional electrical stimulation scheme for the cure of diabetic cystopathy. Due to scarce information to know the diabetic neurophysiological mechanisms of LUT, it is necessary to do an in-depth exploration of the neuromodulation mechanisms of LUT system as a basis of the study of the electrical stimulation in the treatment of cystopathy. Therefore, this electrical stimulation study will be conducted under a diabetic rat model with two-year span. In first year, the experiments will focus on the investigation of the mechanisms of neuromodulation in LUT, including the dependent changes in the neural conductive velocity, characteristics of eletroneurogram, responses of electrical neural stimulation, and the quantification of varied sensory functions. On the basis of the first-year’s results, the second-year experiment will further assess the feasibility of functional electrical stimulation utilized to treat the diabetic bladder dysfunctions, to make detrusor and external urethral sphincter to produce coordinate contractions, and to improve bladder voiding functions. It is expected that the pilot study of functional electrical stimulation in the treatment of diabetic bladder dysfunction will be established within two years. The ultimate goal of the study is to develop an implatable bladder-control microsystem and practically use it in clinic for curing diabetic voiding dysfunction.