Colloque

Evaluation of Implantable Neuroprosthetics in Urology

R.A. Schmidt

Membre a labase

R.A. Schmidt

Résumé du colloque

The use of electrical stimulation has been reported to be quite useful in the management of both neurogenic and non-neurogenic voiding disorders. However, the approach has only been used in highly selected centers, by Urologists with either a clinical or basic science research interest in the subject. The combined experiences reported in the literature have, however, been consistently positive. Neurostimulation has been limited in its therapeutic scope, as compared with other fields, because of limits in the type of equipment available to the clinician. Surface methods for application of current have been most commonly used. This approach, while proven valuable, is limited in its therapeutic scope, and weighs heavily on the time commitments of both the MD administering the treatment and the patient. In addition, there are limits imposed on the patient which impact on comfort and mobility. Implantable devices are not, however, encumbered by these restrictions and have been associated with good results in correcting a number of difficult voiding states. As a result, a multicenter trial has been initiated to evaluate implantable neuroprosthetics for use in the field of Urology. Implants are now being performed at the following University Centers - Santa Clara Medical Center (Stanford), UCLA, UGDavis, Baylor Medical College in Houston, Cleveland Clinic, and McGill University. Three types of procedures are being performed: A Femorocutaneous Implant, A Pudendal Nerve Electrode Implant, and a Pacemaker Implant (Multiple Electrode Implants to Restore Voiding in Spinal Injury Patients). Patients are to be followed for a period of two years. They are being evaluated pre-, three months post-implant, and at six-month intervals thereafter for 18 months. They reflect the UCSF experience in over 200 such implants. These results and the implications regarding the clinical applications and technical challenges will be discussed.