# Triggered sacral neuromodulation to treat neurogenic detrusor overactivity based on algorithmic classification of bladder filling status from wireless pressure data.

> **NIH VA I01** · LOUIS STOKES CLEVELAND VA MEDICAL CENTER · 2024 · —

## Abstract

Neurogenic detrusor overactivity (NDO) resulting from spinal cord injury or disorder (SCI/D) affects 80% of
individuals with SCI/D. It is also associated with peripheral neurodegenerative conditions such as Parkinson’s
disease, multiple sclerosis, diabetic neuropathy, or stroke. NDO causes urinary incontinence that profoundly
impacts dignified, independent living, associates with numerous comorbidities and fall risk, and is a leading
factor in functional decline among the elderly. Urinary incontinence contributes to social isolation and clinical
depression and associates with military service and post-traumatic stress disorder in Veterans.
 Restoring urine storage is consistently cited as a high priority by individuals with NDO. Continuous SNM is
an off-label treatment, which is effective for some individuals with NDO. Triggered sacral neuromodulation—in
which SNM is applied only during the portion of the bladder fill cycle where NDO occurs—could show unique
benefit in treatment in some individuals. While triggered SNM increased bladder capacity in sheep and rats,
feasibility has not yet been demonstrated in humans with NDO.
 The primary goal of this research is to demonstrate the feasibility of increasing bladder capacity and
reducing bladder filling pressures using triggered SNM in Veterans with NDO. This will expand on unique
technologies developed by our team: the UroMonitor, the Context-Aware Threshold (CAT) algorithm, and the
Application Specific Control Unit (ASCU). The UroMonitor is a small, transurethrally-inserted sensor that
wirelessly transmits bladder pressure data. CAT is a wavelet-based algorithm that detects detrusor
contractions from pressure data in real time. The ASCU is a modular neurostimulation platform supporting
wireless communication and custom control software. We will modify and integrate these technologies to
demonstrate the feasibility of automatically triggering SNM in Veterans. A secondary goal is to use the
UroMonitor to determine bladder capacity, detrusor contraction rate, and filling pressures during a
percutaneous SNM evaluation to identify individuals who respond to SNM therapy before a permanent
implantation. Both translational goals will be accomplished through two Specific Aims (SA):
 SA1 will determine the change in bladder response to conditionally-triggered SNM during natural filling
cycles after a two-week sacral neuromodulation evaluation phase in Veterans with NDO. In SA1a we will
integrate a short-range radio and low-power algorithm processor into the ASCU to trigger percutaneous SNM
under algorithm control. In SA1b we will develop and bench-validate a classification algorithm capable of
triggering SNM based on adaptive detection of detrusor contractions. In SA1c we will apply triggered SNM
using data transmitted from the UroMonitor to the ASCU. Triggered SNM will be applied for eight hours at three
timepoints in the two-week percutaneous evaluation phase in eight Veterans. Voided urine volume, time
...

## Key facts

- **NIH application ID:** 10539265
- **Project number:** 5I01RX003687-02
- **Recipient organization:** LOUIS STOKES CLEVELAND VA MEDICAL CENTER
- **Principal Investigator:** Steve Majerus
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-11-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10539265

## Citation

> US National Institutes of Health, RePORTER application 10539265, Triggered sacral neuromodulation to treat neurogenic detrusor overactivity based on algorithmic classification of bladder filling status from wireless pressure data. (5I01RX003687-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10539265. Licensed CC0.

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