U.S. patent number 3,667,477 [Application Number 04/683,944] was granted by the patent office on 1972-06-06 for implantable vesical stimulator.
This patent grant is currently assigned to Canadian Patents and Development Limited. Invention is credited to Robert Nagler, Jacques G. Susset.
United States Patent |
3,667,477 |
Susset , et al. |
June 6, 1972 |
IMPLANTABLE VESICAL STIMULATOR
Abstract
A device and method for artificially electrically stimulating
the body wall of a bladder by an electromagnetic wave which
propagates through the bladder wall and is converted by a receiving
mechanism into electrical stimulating pulses which are conducted to
the bladder wall. But the receiving mechanism receives all its
power from the outside source of electromagnetic energy and since
it uses no internal power source for generating the electrical
pulses to stimulate the bladder wall, a substantially permanent
receiving mechanism is achieved which requires no free charging of
an internal power supply.
Inventors: |
Susset; Jacques G. (Montreal,
Quebec, CA), Nagler; Robert (Chomedey, Quebec,
CA) |
Assignee: |
Canadian Patents and Development
Limited (Ottawa, Ontario, CA)
|
Family
ID: |
4142728 |
Appl.
No.: |
04/683,944 |
Filed: |
November 17, 1967 |
Foreign Application Priority Data
|
|
|
|
|
Nov 25, 1966 [CA] |
|
|
976,490 |
|
Current U.S.
Class: |
607/40 |
Current CPC
Class: |
A61N
1/3787 (20130101); A61N 1/36007 (20130101) |
Current International
Class: |
A61N
1/36 (20060101); A61N 1/378 (20060101); A61N
1/372 (20060101); A61n 001/36 () |
Field of
Search: |
;128/419-424 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Kamm; William E.
Claims
What is claimed is:
1. A system for stimulating the bladder of a mammal with energy
supplied from a source exterior to said mammal including:
a. means exterior to said mammal for providing radio frequency
energy of a predetermined time width and having a predetermined
pulse repetition period larger than said time width;
b. means including an antenna tuned to the radio frequency of means
(a) and a storage capacitor for storing said energy during said
time width, wherein said means (b) is encapsulated in a
biologically inert substance for placing within a mammal;
c. means for generating a stimulating pulse from the source of
energy supply during the interval that means (a) does not emit
radio frequency energy, said means includes a load and a second
capacitor connected to said antenna and a first translating device
in cascade with a second translating device, said second capacitor
adapted to charge, during the time width of said means (a) to
thereby bias said first translating device to cut off during said
time width, and to discharge between the time widths to thereby
allow said first translating device to conduct triggering said
second translating device to conduct discharging said storage
capacitor through said load across which a stimulating pulse is
generated, said means being connected to said antenna and said
storage capacitor and encapsulated in a biologically inert
substance for placing within the mammal; and,
d. means for conveying said stimulating pulse to said bladder wall
including a plurality of electrodes for embedding in the walls of
the bladder so that contraction of the bladder and voiding of urine
from the same occur during the generation of said stimulating
pulse.
2. A system for stimulating the bladder of a mammal with energy
supplied from a source esterior to said mammal including:
a. means exterior to said mammal for providing radio frequency
energy of a predetermined time width and having a predetermined
pulse repetition period larger than said time width;
b. means including an antenna tuned to the radio frequency of means
(a) and a storage capacitor for storing said energy during said
time width, wherein said means (b) is encapsulated in a
biologically inert substance for placing within a mammal;
c. means for generating a stimulating pulse from the source of
energy supply during the interval that means (a) does not emit
radio frequency energy, said means includes a load and a second
capacitor connected to said antenna and a first translating device
in cascade with a second translating device, said second capacitor
adapted to charge, during the time width of said means (a) to
thereby bias said first translating device to cut off during said
time width, and to discharge between the time widths to thereby
allow said first translating device to conduct triggering said
second translating device to conduct discharging said storage
capacitor through said load across which a stimulating pulse is
generated, said means being connected to said antenna and said
storage capacitor and encapsulated in a biologically inert
substance for placing within the mammal wherein the electrodes are
adapted for embedding in the walls of the bladder in two circles,
each electrode equally spaced from the other in its circle, the
circles corresponding to the mid portion of the bladder and between
the tip of the bladder and the lower circle.
3. In a system for stimulating the bladder of a mammal with energy
supplied from a transmitter exterior to said mammal, said
transmitter generating radio frequency energy of a predetermined
time width and pulse repetition period, a stimulator for
contracting the bladder, said stimulator including, an antenna
tuned to the radio frequency of the transmitter, a storage
capacitor for storing said energy during said time width, a load
resistor connected to said storage capacitor, a second capacitor
connected to said antenna and a first translating device which is
in cascade with a second translating device, said second
translating device connected in series with said load resistor and
said storage capacitor, said second capacitor, adapted to charge
during the time width of said transmitter to bias said first
translating device to cut off during said time width, and to
discharge between time widths to thereby allow said first
translating device to conduct, and trigger said second translating
device to conduct discharging said storage capacitor through said
load resistor across which a stimulating pulse is formed, and
conductors connected across said load resistor including electrodes
adapted to be embedded in the bladder wall, for conveying said
stimulating pulse to the walls of the bladder so that contraction
of the bladder and voiding of urine from the same occur during said
stimulating pulses.
Description
This invention relates to a method and apparatus for electrically
stimulating organs of the body.
Stimulation of the bladder by artificial means may become necessary
where a patient, particularly a paraplegic, is unable to properly
urinate. It is estimated that more than 50 percent of all deaths of
paraplegic patients result from urinary complications, due mainly
to the persistence of large amounts of residual urine in the
bladder. The evacuation of this residual urine is normally
impossible because of degenerated motor systems of the bladder.
Traditionally a catheter has been used to rid the bladder of
residual urine; however, recently much effort has been directed to
artificially stimulating, as by electrical impulses, the urinary
bladder to contract causing residual urine to void. Such artificial
stimulus has been accomplished by implanting a pair of electrodes
in the bladder wall and running the wires out of the body wall to
an electrical device which emits on electrical pulse. This pulse
induces contraction of the bladder. Bradley in U.S. Pat. No.
3,236,240 issued 22 Feb. 1966 discloses the use of an implantable
bladder stimulator in which an encapsulated radio receiving device
is implanted in the body of a mammal such that an R.F. signal from
an external transmitter is used to initiate a pulsed current
through electrical wires embedded in the bladder wall so as to
induce contraction thereof.
Such stimulators suffer from several disadvantages; they are bulky;
there is a danger of premature discharge from the battery in the
receiver, if receiver is so equipped, due to infiltration of body
fluid into the encapsulated battery disposed within the body;
repeated surgery is necessary to replace the battery. Moreover,
these devices do not induce sufficient contraction of the bladder
in humans to cause complete evacuation of the residual urine.
The present invention overcomes the above disadvantages by
stimulating the bladder within the body cavity with a series of
electrical impulses of predetermined duration and frequency until
voiding ensues. These electrical impulses are generated within the
body cavity from energy and a control signal supplied from outside
the body.
The invention contemplates a system for stimulating a bladder of a
mammal with energy supplied from a source exterior to said mammal
including:
1. MEANS EXTERIOR TO SAID MAMMAL FOR PROVIDING RADIO FREQUENCY
ENERGY OF A PREDETERMINED TIME WIDTH AND HAVING A PREDETERMINED
PULSE REPETITION PERIOD LARGER THAN SAID TIME WIDTH;
2. MEANS FOR RECEIVING AND STORING SAID ENERGY DURING SAID TIME
WIDTH TO PROVIDE A SOURCE OF ENERGY SUPPLY, SAID MEANS ENCAPSULATED
IN A BIOLOGICALLY INERT SUBSTANCE FOR PLACING WITHIN THE BODY;
3. MEANS FOR GENERATING A STIMULATING PULSE FROM THE SOURCE OF
ENERGY SUPPLY DURING THE INTERVAL THAT MEANS (1) DOES NOT EMIT
RADIO FREQUENCY ENERGY, SAID MEANS ENCAPSULATED IN A BIOLOGICALLY
INERT SUBSTANCE FOR PLACING WITHIN THE BODY; AND
4. MEANS FOR CONVEYING SAID STIMULATING PULSE TO SAID BLADDER WALL
INCLUDING A PLURALITY OF ELECTRODES FOR EMBEDDING IN THE WALLS OF
THE BLADDER SO THAT CONTRACTION OF THE BLADDER AND VOIDING OF THE
URINE OCCUR DURING THE GENERATION OF SAID STIMULATING PULSE.
The invention will now be described by way of example reference
being had to the accompanying drawings in which:
FIG. 1 is a representation of the stimulator in a body of a mammal
such as a human;
FIG. 2 is a representation of the electrodes embedded in the
bladder wall;
FIG. 3 is a schematic diagram of the receiver;
FIG. 4 is a graph indicating the timing relation between the signal
output of the transmitter and that of the stimulator; and
FIG. 5 is a graph indicating the efficiency of voiding a human
bladder using the embodiments of the invention.
Referring to FIG. 1, a stimulator 10 including an antenna element
11 and an energy storing and pulse forming circuit 12 is disposed
in a body 13 by surgery. The antenna element 11 is embedded near
the body wall 14 and the energy storing and pulse forming circuit
12 in the body cavity 15. An interconnecting cable 16, later to be
described, is disposed between elements 11 and circuit 12. Embedded
in the walls of a bladder 17 are platinum disc electrodes 18
electrically connected to the circuit 12 by insulated wires 19. An
exterior transmitter 20 excites the stimulator 10 in a manner later
to be described.
Referring to FIG. 2, six disc electrodes 18 of platinum (although
any biologically inert and non-oxidizing material may be used such
as tantalum, vanadium, stainless steel or graphite) having a
diameter of 7 mm are embedded into the bladder wall 21 by making a
small tunnel 22 with a fine mosquito forceps. A disc electrode 18
is inserted into the tunnel 22 and the entrance 23 thereof is
closed with a fine silk suture 24 in order to maintain the
electrode 18 in position. The six electrodes 18 are disposed at
regular intervals along two concentric circles of 3 electrodes
each; one circle, corresponding to the mid portion of the bladder,
the other circle, midway between the tip of the bladder and the
lower circle.
In order to ensure a fast spreading of current the polarity of the
electrodes are alternated and placed in the following order: in the
lower circle a negative electrode in the anterior wall 26, a
positive electrode in the right and left lateral wall 27, 28; in
the upper circle, a positive electrode in the posterior wall 29 and
two negative electrodes on the anterior wall 31. All the electrodes
in both circles are equally spaced from all the other
electrodes.
Referring to FIG. 3, the stimulator 10 comprises two elements, the
receiving element 11 and the energy storing and pulse forming
circuit 12, interconnected by the cable 16. The element 11 and
circuit 12 are encapsulated within a biologically inert substance
101 such as silicone rubber or as sold under the trade mark
"Silastix." Within the element 11 an antenna comprising a coil 102
wound on a ferrite rod the ends of which are respectively connected
to the inner conductors 103, 104 of the cable 16. The conductors
103 and 104 terminate across a capacitor 106 which has one terminal
connected to the cathode of a diode 107 and the anode of a diode
108. The other terminal of the capacitor 106 is secured to a common
electrical reference conductor 109. Two capacitors 111 and 112 are
interconnected between the anode of diode 107, the cathode of diode
108, and the conductor 109. Two resistors 113, 114 connect the base
of a transistor (first translating device) 116 to the anode and
cathode of the diodes 107 and 108. The emitter of the transistor
116 is connected to the conductor 109 while the collector thereof
is connected to the base of a transistor 117 through a resistor 118
such that the two transistors 116 and 117 are in cascade. The anode
of the diode 107 is directly connected to the emitter of the
transistor 117, and coupled to the base of the transistor 117
through a resistor 119. The cathode of a 20-volt zener diode 121 is
also connected to the anode of diode 107, while the anode of the
zener diode 121 connects to the conductor 109. This zener diode 121
limits the amount of charge in the storage capacitor 111 to no more
than 20 volts as will become apparent. The collector of the
transistor 117 is connected through a resistor 122 to the conductor
109 while a capacitor 123 connects this collector to a positive
electrode terminal 124. Any signal at the collector of the
transistor 117 is fed back through a capacitor 126 to the base of
the transistor 116. The conductor 109 terminates at a negative
electrode terminal 127. To each of the electrode terminals 124 and
127 respectively the electrodes 18 are connected by conducting
wires 19 such that an equal number of electrodes 18 are connected
to each terminal. The electrodes 18 connected to terminal 124 are
disposed in the bladder wall 21, one in the lower circle on the
anterior wall, the other two in the upper circle on the anterior
wall. Those electrodes 18 connected to the positive terminal 127
are disposed in the bladder wall 21, one each in the right and left
lateral wall in the lower circle, and the third in the posterior
wall of the upper circle.
The stimulator 10 is encapsulated in a biologically inert
substance, for example, silicone rubber, and by surgery the
receiving element 11 is embedded in the body wall near the surface
thereof while the larger energy storing and pulse forming circuit
12 is embedded in the body cavity under the recti muscles. The
electrodes 18 are embedded in the walls 21 of the bladder 17 as
previously described.
The transmitter 20, which may be of standard design is excited to
provide a continuous electromagnetic wave having a specific time
width and pulse repetition frequency which induces voiding of the
bladder in a manner which will become apparent. During transmitter
excitation energy is received by element 11 and stored in circuit
12. During that period of time when the transmitter is
automatically turned off the stored energy in circuit 12 is
discharged and the pulse is conveyed to the electrodes 18 in a
manner now to be explained.
During excitation of the transmitter 20, the element 11 detects the
radiation because the coil 102 and capacitor 106 make the element
11 a tuned circuit for the frequency of operation of the
transmitter 20, for example, 100 kilohertz. The storage capacitor
111 is charged negatively during that part of the cycle that
conductor 103 is negative with respect to conductor 104; during the
other half cycle, the diode 107 prevents current from flowing to
charge capacitor 111. During this half cycle, when conductor 103 is
positive with respect to conductor 104, the capacitor 112 is
charged positive. This places the junction of the resistors 113 and
114, the base of the transistor 116, positive with respect to the
conductor 109 biasing transistors 116 and 117 to cut off. This
makes the base of transistor 117 more negative than its emitter and
causes conduction thereof. By virtue of this conduction, a trigger
signal appears at the base of transistor 117 causing it to conduct
through the resistance 122 discharging storage capacitor 111. The
voltage appearing across the resistor 122 appears across the
terminals 127 and 124 and is conveyed to the electrodes 18. The
capacitor 123 provides isolation and coupling. When the transmitter
20 is re-excited transistors 116 and 117 are biased to cut off by
the rapid charging of capacitor 112. Charging of the storage
capacitor 111 is also re-instituted. This method is then repeated
10 - 20 times per second in a manner as will now be described.
Referring to FIG. 4 the transmitter 20 emits a continuous wave
signal having a time width of M milliseconds and a pulse repetition
period of N milliseconds, it being provided the N is a number
greater than M.
The stimulator 10 produces, as is now apparent, a stimulating pulse
when the transmitter is not emitting a signal. As a result, the
stimulator 10 provides a pulse having a time width of (N-M)
milliseconds and a pulse repetition period of N milliseconds. Now
if N is selected to be 100 and M, 99, the stimulator will provide a
stimulating pulse of 1 millisecond duration and cycle at a
frequency of 10 cycles per second because the transmitter 20 has a
pulse repetition period of 100 milliseconds and a time width of 99
milliseconds. If the pulse repetition period, M, of the transmitter
20 is 49 milliseconds, a cycling of 20 c.p.s. is obtained. When the
transmitter 20 is placed next to the body wall and turned on the
stimulator 10 pulses and urine flows.
Since the storage capacitor 111 is only minutely discharged during
any period (N-M), it is preferable during the operation of the
stimulator 10, that as complete voiding of the bladder is
accomplished, that the transmitter be slowly moved away from the
body wall prior to the turning off of the transmitter permanently.
In this manner, the storage capacitor 111 is charged to a lesser
degree during the time width M of the transmitter. This reduction
in the storing of energy prevents a final large discharge of
capacitor 111 through transistor 117 and a resulting large
stimulating pulses which may be detrimental to the user when the
transmitter is turned off. The maximum amplitude of the stimulating
pulse is controlled by the zener diode 121, which limits the
storage potential across the storage capacitor 111. This is
preferably set at 20 volts.
The following parts list gives suitable values of the components of
the stimulator 10 when the transmitter frequency of 100 kilohertz
with a time width of 99 milliseconds and a pulse repetition period
of 1/10 second is used.
resistors 113 33K ohms 114 18K ohms 118 500 ohms 119 5K ohms 122
500 ohms capacitors 106 .01 ufd 111 47 ufs (tantalum) 112 .002 ufd
123 180 ufd 126 100 pf diodes 107 silicone 108 silicone 121 zener
20V transistors 116 silicone 117 silicone
EXAMPLE 1
(The Use of the Receiver for Bladder Stimulation in Dogs)
Receivers which were designed to provide a bipolar square wave
pulse of 10 cycles per second for a duration of 1 millisecond and
had an amplitude of 10 volts and having electrical circuit
substantially as shown in FIG. 3 were implanted in four dogs -- two
males and two females averaging 35 pounds in weight.
Prior to the implantation, a bilateral sacral neurotomy was
performed following the usual technique in the same operating
stage. An abdominal incision was made. Nervi erigentes and
hypo-gastric nerves were first severed to leave no doubt about the
completeness of vesical denervation.
Six electrodes were implanted in the bladder wall according to the
above-described technique. These electrodes had been connected to
the energy storing and pulse forming circuit 12 in two bundles of
three, making easy the identification of positive and negative
poles. The encapsulated circuit 12 and receiving element 12 were
thread lateral to the left rectus muscle and placed in the
subcutaneous tissue in the flank midway between abdominal and
sacral incisions.
In the four animals, the initial stimulation during the operation
was entirely successful and caused complete vesical evacuation.
The stimulation was carried out four times a day at 9 A.M., 1 P.M.,
5 P.M. and 9 P.M. The dog was kept on normal fluid intake. The
average flow obtained by stimulation corresponded to figures found
during acute experiments with the corresponding current. That is to
say, about 3 to 4 cc/sec. No major post-operative complication
occurred during the first weeks in any of the dogs. The dogs looked
healthy; none was paralyzed due to the lower level of the nerve
section and urinary incontinence was not noted.
In one dog, the stimulation became suddenly inefficient. The dog
was sacrificed and two electrodes were found to be disconnected due
to breaking of the conductive wires.
In the second dog, the effect of the stimulation became gradually
less efficient over the 9th and 10th day when two electrodes lost
their contact with the vesical wall.
In the third dog, the stimulation remained efficient for 2 weeks.
At that time, the skin ulcerated in the vicinity of the receiver
element 12. The skin finally ruptured and the receiver element 12
and encapsulated circuit 12 were rejected. This compelled us to
sacrifice the dog.
The fourth dog did extremely well. For 3 months stimulation caused
complete vesical emptying. A cinecystogram was done which showed
complete vesical evacuation. Unfortunately, this dog died of
pulmonary infection. The post-mortem examination failed to
demonstrate any burn at the point of implantation of electrodes.
The bladder capacity was still in the initial range of 250 cc and
the vesical wall appeared healthy.
EXAMPLE 2
(Electromagnetic Converter for Bladder Stimulation in Humans)
A stimulator 10 of electrical circuit and electrical parameters as
previously described was used as a human stimulator. Eight platinum
disc electrodes were implanted in the bladder according to the
above described technique in 2 circles of 4 electrodes equally
spaced from each other in order to provide sufficient stimulation
to the larger size human bladder. As before, the electrodes 18 were
connected to the circuit 12 in two bundles of four making easy
identification of the positive and negative poles respectively
connected to terminals 123 and 124. The stimulator 10 was thread
lateral to the left rectus muscle and placed in a subcutaneous
tissue in a flank midway between the abdominal and sacral
incisions. As before the stimulator 10 was insulated with apoxy and
silicone rubber as were the interconnecting wires 19 between the
platinum disc electrodes 18 and the stimulator 10 prior to
insertion within the body.
A stimulator 10 was implanted in a 30 year old male who sustained a
spinal cord injury at the level of T4 some 3 years previously.
Subarachnoidal alcoholization carried out some 2 years subsequent
to the spinal cord injury left him with complete flaccidity of the
lower limbs and pelvic floor, and complete absence of sensation
below T4. The anal sphincter was atonic and the bulbo-cavernosus
reflex absent.
The upper urinary tract was normal on Intravenous Pyelogram and
there was no vesico-ureteral reflux present on the cystogram. The
urine was markedly purulent and contained various bacteria on
repeated bacteriological studies. A cystometrogram revealed
flaccidity of the bladder. On cystoscopy, the bladder mucosa was
markedly inflamed with moderate trabeculation and cellule
formation. The bladder neck was widely open and there was no
evidence of urethral obstruction.
Numerous unsuccessful attempts were made to remove the indwelling
catheter utilizing large doses of urecholine. He was unable to void
and 600 cc of residual urine were regularly present in the bladder.
He spiked a high fever not infrequently and on three occasions
litholapaxy for bladder calculi was carried out.
During the surgery necessary for the implanting stimulator no
response was noticed. The bladder was continuously drained by an
indwelling Foley catheter for 1 week following surgery during which
time no stimulation was attempted. From the second postoperative
week, the patient stimulated his bladder every 3 to 4 hours
according to fluid intake. The stimulation can be carried out
across his clothes either in bed or in a wheel chair. He places the
external transmitter 20 close to, but not touching the skin, over
the internal receiving element 12 and commences stimulation by
exciting the transmitter. The urinary flow appears almost
immediately. The voltage reaching the electrodes is inversely
proportional to the distance between the external transmitter 20
and internal receiving element 12 allowing for current adjustment
after implantation.
Referring to FIG. 5 it will be noted that in the postoperative
period, the urinary flow was poor with a high residual urine
volume. Over the subsequent 10 weeks, the urine flow rate increased
and the residual urine volume decreased and then stabilized to an
average flow of about 10 cc/sec with a maximum of 15 cc/sec.
Residual urine varies between 0 - 20 cc with voiding of about 200 -
600 cc. When flow stops the patient discontinues stimulation. The
patient has not complained of pain during stimulation. 2 weeks
following surgery, his urine was clear and showed only occasional
white blood cells and minimal bacteriuria. However, proteus
mirabilis had been repeatedly grown in the urine during periods
when repeated catherizations for residual urine were undertaken
throughout the postoperative period, determination or chronic
pyelonephritis may explain the persisting urinary infection. A
cinecystogram done 10 weeks postoperatively showed a homogenous
contraction of the bladder comparable to a normal vesical
contraction. The patient had not developed vesico-ureteral reflux.
The Intravenous Pyelogram was unchanged and a cystoscopy done 3
months following the procedure failed to demonstrate any trace of
local changes in bladder mucosa at the sites of electrode
implantation. Between stimulations, there is no urinary
incontinence as long as the patient does not strain. Increase in
the intra-abdominal pressure results in leakage of urine per
urethra because of the incompetence of both internal and external
sphincters.
* * * * *