J Appl Biomed 20:56-69, 2022 | DOI: 10.32725/jab.2022.009

Kilohertz alternating current neuromodulation of the pudendal nerves: effects on the anal canal and anal sphincter in rats

Rosa L. Coolen^{1, *}, Koen M. Emmer², Panagiota I. Spantidea¹, Els van Asselt¹, Jeroen R. Scheepe¹, Wouter A. Serdijn², Bertil F. M. Blok¹

¹ Erasmus Medical Center, Department of Urology, Rotterdam, Zuid-Holland, Netherlands

² Delft University of Technology, Section Bioelectronics, Delft, Zuid-Holland, Netherlands

The first two objectives were to establish which stimulation parameters of kilohertz frequency alternating current (KHFAC) neuromodulation influence the effectiveness of pudendal nerve block and its safety. The third aim was to determine whether KHFAC neuromodulation of the pudendal nerve can relax the pelvic musculature, including the anal sphincter. Simulation experiments were conducted to establish which parameters can be adjusted to improve the effectiveness and safety of the nerve block. The outcome measures were block threshold (measure of effectiveness) and block threshold charge per phase (measure of safety). In vivo, the pudendal nerves in 11 male and 2 female anesthetized Sprague Dawley rats were stimulated in the range of 10 Hz to 40 kHz, and the effect on anal pressure was measured. The simulations showed that block threshold and block threshold charge per phase depend on waveform, interphase delay, electrode-to-axon distance, interpolar distance, and electrode array orientation. In vivo, the average anal pressure during unilateral KHFAC stimulation was significantly lower than the average peak anal pressure during low-frequency stimulation (p < 0.001). Stimulation with 20 kHz and 40 kHz (square wave, 10 V amplitude, 50% duty cycle, no interphase delay) induced the largest anal pressure decrease during both unilateral and bilateral stimulation. However, no statistically significant differences were detected between the different frequencies. This study showed that waveform, interphase delay and the alignment of the electrode along the nerve affect the effectiveness and safety of KHFAC stimulation. Additionally, we showed that KHFAC neuromodulation of the pudendal nerves with an electrode array effectively reduces anal pressure in rats.

Keywords: Anal sphincter; Electrical stimulation; High-frequency neuromodulation; Neurostimulation; Pelvic floor; Pudendal nerves

Grants and funding:

This study is supported by Stichting Urologisch Wetenschappelijk Onderzoek (SUWO). The funding source had no involvement in study design, data collection, analysis, interpretation of the data, writing of the report, and submission of the article for publication.

Conflicts of interest:

The authors have no conflict of interests to declare.

Received: November 16, 2021; Revised: May 6, 2022; Accepted: June 21, 2022; Published: June 21, 2022  Show citation