An interventional study of Neurometer Neurotron CPT and Cystometry in Urinary Bladder, Underactive, sponsored by Duke University. Completed at 1 site in United States. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-07-16.
Sponsored by Duke University · Not applicable, Interventional, and Basic science
The purpose of this study is to determine the influence of intravesical (bladder) electrical stimulation and intraurethral electrical stimulation on bothersome symptoms and bladder function in neurologically-intact adult women with underactive bladder. The investigators hypothesize that electrical stimulation will decrease bothersome urinary symptoms relative to baseline and increase voided percentage during pressure-flow studies compared to their routine clinical exam.
Background and Significance: The storage and elimination of urine is regulated by neural circuits in the brain and spinal cord to coordinate function between the urinary bladder and the urethra. During micturition (bladder emptying), the elimination of urine is facilitated by bladder muscle (detrusor) contraction and urethral and pelvic floor muscle relaxation. Urine flow through the urethra also activates sensory nerves to amplify bladder contractions and maintain efficient bladder emptying. Incomplete emptying and urinary retention occur when these mechanisms are disrupted or poorly coordinated.
Incomplete emptying due to underactive bladder is a poorly understood health concern that symptomatically affects up to 40% of the population, with the highest prevalence of symptoms in older men and women. Despite the high prevalence of symptoms, the diagnosis of an underactive bladder remains low due to the lack of consistent terminology and standardized diagnostic criteria. This results in defining underactive bladder by a symptom complex that may involve reduced motor drive (detrusor underactivity) during bladder emptying and/or reduced sensory drive during filling and emptying. Symptoms experienced by persons with underactive bladder include nocturia, urinary frequency, urgency, incontinence, slow stream, hesitancy, straining, and sensation of incomplete emptying. The most common symptoms are nocturia, slow stream, frequency, hesitancy, and the impact of these symptoms on quality of life is substantial for many patients.
The management options for persons with underactive bladder include double-void, intermittent self-catheterization, or pharmacotherapy. However, these treatments are associated with poor quality of life and patients often fail to completely resolve the lower urinary tract symptoms (LUTS). There is a need to clarify the pathological mechanisms underlying underactive bladder to improve therapeutic outcomes. One approach to clarify reduced sensory drive is to evaluate the functional integrity of sensory nerves with quantitative sensory testing. Current perception threshold (CPT) testing delivers electrical stimulation to activate nerve fibers that evoke sensory perception, and changes in bladder sensory pathways were demonstrated in persons with diabetic detrusor underactivity. These diagnostic tests, however, have not been applied to neurologically intact adult women with underactive bladder and may provide insight into pathological sensory dysfunction.
The proposed research will quantify sensory nerve sensitivity in the bladder and urethra in adult women with underactive bladder. The investigators will then amplify sensory nerve activity via continuous electrical stimulation to improve LUTS associated with underactive bladder. Achieving the proposed objectives will establish a prognostic marker for rationally guided electrical stimulation in women with underactive bladder. Understanding how these mechanisms contribute to impaired emptying in underactive bladder will enable the development of novel therapeutics to enhance quality of life.
Has the below response to 2 of the 3 questions:
Questions regarding self-reported poor sensation during bladder filling or emptying (one or more of the below)
Questions regarding self-reported bothersome urinary symptoms (one or more of the below)
Exclusion Criteria:
This procedure is specific to the urethral stimulation arm. A sterile stimulation catheter (custom, 7-French) will be placed in the urethra and positioned with the electrode contact 10-14 mm from the bladder neck to stimulate the proximal urethra. A single return electrode will also be placed on the abdominal skin above the pubic bone. Stimuli will be delivered as 0.2 ms charge-balanced biphasic rectangular current pulses. Stimulation frequency will be 2-20 Hz and amplitude will be adjusted individually to 80% of the maximum tolerable intensity. Electrical stimulation will be applied to the proximal urethra at "strong desire to void" during cystometry. The participant will then be given permission to void at "maximum cystometric capacity" with continuous intraurethral stimulation.
Device: Neurometer Neurotron CPT · Procedure: Cystometry · Procedure: Pressure-flow study
This procedure is specific to the bladder stimulation arm. A sterile stimulation catheter (custom, 7-French) will be placed in the bladder through the urethra and the electrode contacts will be positioned to be floating within the bladder. A single return electrode will also be placed on the abdominal skin above the pubic bone. Stimuli will be delivered as 0.2 ms charge-balanced biphasic rectangular current pulses. Stimulation frequency will be set at 20 Hz and amplitude will be adjusted individually to 80% of the maximum tolerable intensity. Electrical stimulation will be applied to bladder sensory nerves for up to 60 minutes prior to the start of urodynamic studies.
Device: Neurometer Neurotron CPT · Procedure: Cystometry · Procedure: Pressure-flow study
All participants will undergo CPT testing. A Neurotron catheter (12-French) with electrode will be inserted through the urethra into the bladder. The catheter balloon will be inflated and positioned at the urethrovesical junction to stimulate the urethra 10-14 mm from the bladder neck. For bladder stimulation, the catheter balloon will be deflated and the catheter will be advanced into the bladder. The device will deliver sine wave stimulus pulses at 5, 250, and 2,000 Hz. CPT will be established using an automated forced choice paradigm by the method of levels. Testing order of the bladder and urethra will be randomized between participants.
After bladder stimulation or during intraurethral stimulation, cystometry will be performed to assess bladder sensation and storage. A dual-chamber 8-French catheter will be passed through the urethra into the bladder for retrograde filling. A second 8-French catheter will be placed in the vagina to measure intra-abdominal pressure. A stimulation electrode catheter will only be inserted in the intraurethral stimulation arm. EMG pads will then be placed at 3 and 9 o'clock on each side of the perineum. The bladder will then be filled with room-temperature sterile saline solution in a retrograde fashion using a pump. Bladder sensation and urgency will be assessed while filling.
A pressure flow study will be performed to evaluate voiding function after stimulation. The transurethral and intra-vaginal catheters are left in place after cystometry and the participant will be asked to void around them, into a commode. Bladder and abdominal pressures will be recorded, as well as urine flow over time.
Voiding Efficiency
Use of intraurethral electrical stimulation or intravesical electrical stimulation to assess increase in voided percentage during pressure-flow studies. Voiding efficiency is calculated as voided volume divided by the sum of voided volume and residual volume.
Time frame: Baseline, pressure-flow study (up to 60 minutes)
Change in Bothersome Symptoms and Sensation
Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29) to assess whether electrical stimulation decreases urinary bothersome symptoms and increases bladder sensation during filling and emptying. Scores range from 0 (least severe) to 100 (most severe). Higher scores indicate greater severity of lower urinary tract symptoms.
Time frame: baseline and post study procedures, up to 60 minutes
Current Perception Threshold
Assess bladder or urethral current perception threshold (CPT) in women with underactive bladder compared to normative values. The CPT value determined by the device is defined as the average of the minimum amplitude of the stimulus consistently detected and the stimulus 40 µA lower that was consistently not detected.
Time frame: CPT, up to 60 minutes
Cystometry Volume
Use of intravesical electrical stimulation to assess volumes during cystometry. Bladder sensation and urgency assessed at volume of first sensation during bladder filling, first desire to void, strong desire to void, and maximum cystometric capacity.
Time frame: cystometry before stimulation and after stimulation (up to 60 minutes)
Bladder Contraction Strength
Use of intraurethral electrical stimulation to assess contraction strength relative to baseline. Bladder pressure (cmH2O) is recorded over time during voiding.
Time frame: Baseline, pressure-flow study (up to 60 minutes)
Bladder Contraction Duration
Use of intraurethral electrical stimulation to assess flow duration during a bladder contraction relative to baseline.
Time frame: Baseline, pressure-flow study (up to 60 minutes)
| Milestone | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation |
|---|---|---|
| Started | 12 | 8 |
| Completed | 12 | 8 |
| Not completed | 0 | 0 |
Use of intraurethral electrical stimulation or intravesical electrical stimulation to assess increase in voided percentage during pressure-flow studies. Voiding efficiency is calculated as voided volume divided by the sum of voided volume and residual volume.
| voided percentage | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation |
|---|---|---|
| Baseline | 32 ± 31 | 53 ± 22 |
| Pressure-flow study (up to 60 minutes) | 43 ± 37 | 46 ± 27 |
Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29) to assess whether electrical stimulation decreases urinary bothersome symptoms and increases bladder sensation during filling and emptying. Scores range from 0 (least severe) to 100 (most severe). Higher scores indicate greater severity of lower urinary tract symptoms.
| CASUS questionnaire scores | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation |
|---|---|---|
| Baseline | 52 ± 15 | 53 ± 11 |
| Post Study Procedures | 46 ± 16 | 39 ± 18 |
Assess bladder or urethral current perception threshold (CPT) in women with underactive bladder compared to normative values. The CPT value determined by the device is defined as the average of the minimum amplitude of the stimulus consistently detected and the stimulus 40 µA lower that was consistently not detected.
| mA (maximum amplitude) | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation |
|---|---|---|
| 5 Hz | 8.57 ± 3.23 | 8.27 ± 3.61 |
| 250 Hz | 9.99 ± 0.00 | 9.04 ± 0.40 |
| 2000 Hz | 9.99 ± 0.00 | 9.99 ± 0.00 |
Use of intravesical electrical stimulation to assess volumes during cystometry. Bladder sensation and urgency assessed at volume of first sensation during bladder filling, first desire to void, strong desire to void, and maximum cystometric capacity.
| mL | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation |
|---|---|---|
| first sensation of bladder filling - before stimulation | 290 ± 159 | 253 ± 122 |
| first sensation of bladder filling - after stimulation | 281 ± 146 | 357 ± 135 |
| maximum cystometric capacity - before stimulation | 517 ± 263 | 458 ± 225 |
| maximum cystometric capacity - after stimulation | 528 ± 253 | 646 ± 211 |
Use of intraurethral electrical stimulation to assess contraction strength relative to baseline. Bladder pressure (cmH2O) is recorded over time during voiding.
| cmH2O | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation |
|---|---|---|
| Baseline | 11 ± 32 | 33 ± 41 |
| Pressure-flow study (up to 60 minutes) | 21 ± 18 | 25 ± 27 |
Use of intraurethral electrical stimulation to assess flow duration during a bladder contraction relative to baseline.
| mL/s | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation |
|---|---|---|
| Baseline | 8 ± 3 | 15 ± 3 |
| Pressure-flow study (up to 60 minutes) | 15 ± 12 | 13 ± 7 |
Collected over One month post study completion. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Intravesical Electrical Stimulation | 0/12 (0%) | 0/12 (0%) | 3/12 (25%) |
| Intraurethral Electrical Stimulation | 0/8 (0%) | 0/8 (0%) | 0/8 (0%) |
| Event | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation |
|---|---|---|
| Urinary tract infectionRenal and urinary disorders | 3/12 | 0/8 |
| Age, Continuous(years) | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation | Total |
|---|---|---|---|
| Mean | 69 ± 6 | 67 ± 4 | 68 ± 12 |
| Sex: Female, Male(Participants) | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation | Total |
|---|---|---|---|
| Female | 12 | 8 | 20 |
| Male | 0 | 0 | 0 |
| Ethnicity (NIH/OMB)(Participants) | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation | Total |
|---|---|---|---|
| Hispanic or Latino | 0 | 0 | 0 |
| Not Hispanic or Latino | 11 | 8 | 19 |
| Unknown or Not Reported | 1 | 0 | 1 |
| Race (NIH/OMB)(Participants) | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 1 | 1 | 2 |
| White | 10 | 7 | 17 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 1 | 0 | 1 |
| Region of Enrollment(participants) | Intravesical Electrical Stimulation | Intraurethral Electrical Stimulation | Total |
|---|---|---|---|
| United States | 12 | 8 | 20 |
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Duke University