Detecting Urinary Bladder Contractions: Methods and Devices


In patients suffering from neurogenic detrusor overactivity, continence can be regained by conditional stimulation of the dorsal genital nerve (DGN); that is applying electrical stimulation to the DGN at the onset of an involuntary contraction. For this scheme to work, a sensor capable of reliably detecting the onset of bladder contractions is needed. This article reviews the methods proposed for or associated with detection of bladder contractions, and their applicability to onset detection is assessed. Fourteen methods are described in this review; bladder pressure, urethral sphincter EMG and anal sphincter EMG are the most promising options for onset detection. For all three modalities, however, further research is needed before clinical application becomes viable.

Share and Cite:

Melgaard, J. and Rijkhoff, N. (2014) Detecting Urinary Bladder Contractions: Methods and Devices. Journal of Sensor Technology, 4, 165-176. doi: 10.4236/jst.2014.44016.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] De Groat, W.C. (1993) Anatomy and Physiology of the Lower Urinary Tract. Urologic Clinics of North America, 20, 383-401.
[2] Andersson, K. (2004) Mechanisms of Disease: Central Nervous System Involvement in Overactive Bladder Syndrome. Nature Clinical Practice Urology, 1, 103-108.
[3] Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., van Kerrebroeck, P., Victor, A. and Wein, A. (2002) The Standardisation of Terminology of Lower Urinary Tract Function: Report from the Standardisation Sub- Committee of the International Continence Society. Neurourology and Urodynamics, 21, 167-178.
[4] Becker, D., Sadowsky, C.L. and McDonald, J.W. (2003) Restoring Function after Spinal Cord Injury. The Neurologist, 9, 1.
[5] Lawrenson, R., Wyndaele, J.J., Vlachonikolis, I., Farmer, C. and Glickman, S. (2001) Renal Failure in Patients with Neurogenic Lower Urinary Tract Dysfunction. Neuroepidemiology, 20, 138-143.
[6] Vodusek, D.B., Light, J.K. and Libby, J.M. (1986) Detrusor Inhibition Induced by Stimulation of Pudendal Nerve Afferents. Neurourology and Urodynamics, 5, 381-389.
[7] Kirkham, A.P.S., Shah, N.C., Knight, S.L., Shah, P.J.R. and Craggs, M.D. (2001) The Acute Effects of Continuous and Conditional Neuromodulation on the Bladder in Spinal Cord Injury. Spinal Cord, 39, 420-428.
[8] Wenzel, B.J., Boggs, J.W., Gustafson, K.J. and Grill, W.M. (2006) Closed Loop Electrical Control of Urinary Continence. The Journal of Urology, 175, 1559-1563.
[9] Corey, E.L., Boyce, W., Vest, S. and French, C. (1951) Electro-Potential Changes in Human Urinary Bladder: A Method of Measurement. Journal of Applied Physiology, 3, 631-636.
[10] Corey, E., Boyce, W. and French, C. (1952) Electro Potential and Pressure Variations in the Normal Human Urinary Bladder. Journal of Applied Physiology, 5, 38-42.
[11] Brunsting, C. (1958) An Interpretation of the Urinary Bladder Electrocystogram as Artefact. Journal of Urology, 79, 165.
[12] Ballaro, A., Mundy, A.R., Fry, C.H. and Craggs, M.D. (2001) A New Approach to Recording the Electromyographic Activity of Detrusor Smooth Muscle. Journal of Urology, 166, 1957-1961.
[13] Fowler, C.J., Griffiths, D. and de Groat, W.C. (2008) The Neural Control of Micturition. Nature Reviews Neuroscience, 9, 453-466.
[14] Brading, A.F. (1987) Physiology of Bladder Smooth Muscle. In: Torrens, M. and Morrison, J.F.B., Eds., Physiology of the Lower Urinary Tract, Springer, London, 161-191.
[15] Sjogren, C., Andersson, K.E., Husted, S., Mattiasson, A. and Moller-Madsen, B. (1982) Atropine Resistance of Transmurally Stimulated Isolated Human Bladder Muscle. Journal of Urology, 128, 1368-1371.
[16] Bayliss, M., Wu, C., Newgreen, D., Mundy, A. and Fry, C. (1999) A Quantitative Study of Atropine-Resistant Contractile Responses in Human Detrusor Smooth Muscle, from Stable, Unstable and Obstructed Bladders. Journal of Urology, 162, 1833-1839.
[17] Tagliani, M., Candura, S., Di Nucci, A., Franceschetti, G., D’Agostino, G., Ricotti, P., Fiori, E. and Tonini, M. (1997) A Re-Appraisal of the Nature of the Atropine-Resistant Contraction to Electrical Field Stimulation in the Human Isolated Detrusor Muscle. Naunyn-Schmiedeberg’s Archives of Pharmacology, 356, 750-755.
[18] Wu, C., Bayliss, M., Newgreen, D., Mundy, A. and Fry, C. (1999) A Comparison of the Mode of Action of ATP and Carbachol on Isolated Human Detrusor Smooth Muscle. Journal of Urology, 162, 1840-1847.
[19] Visser, A. and Van Mastrigt, R. (2000) Simultaneous Recording of Mechanical and Intracellular Electrical Activity in Human Urinary Bladder Smooth Muscle. BJU International, 86, 113-120.
[20] Fujii, K. (1988) Evidence for Adenosine Triphosphate as an Excitatory Transmitter in Guinea-Pig, Rabbit and Pig Urinary Bladder. The Journal of Physiology, 404, 39-52.
[21] Wenzel, B.J., Boggs, J.W., Gustafson, K.J., Creasey, G.H. and Grill, W.M. (2006) Detection of Neurogenic Detrusor Contractions from the Activity of the External Anal Sphincter in Cat and Human. Neurourology and Urodynamics, 25, 140-147.
[22] Craggs, M. (2007) Neuromodulation Device for Pelvic Dysfunction. WO2007/101861 A1.
[23] Craggs, M. (2009) Conditional Neuromodulation Using Trans-Rectal Stimulation in Spinal Cord Injury. Neurourology and Urodynamics, 28, 836.
[24] Edirisinghe, N.A. (2011) A Novel Wearable Electronic Device for Treating Neurogenic Detrusor Overactivity by Conditional Neuromodulation. Master’s Thesis, University College London, London.
[25] Hansen, J., Borau, A., Rodriguez, A., Vidal, J., Sinkjaer, T. and Rijkhoff, N.J.M. (2007) Urethral Sphincter EMG as Event Detector for Neurogenic Detrusor Overactivity. IEEE Transactions on Biomedical Engineering, 54, 1212-1219.
[26] Opisso, E., Borau, A. and Rijkhoff, N. (2011) Urethral Sphincter EMG-Controlled Dorsal Penile/Clitoral Nerve Stimulation to Treat Neurogenic Detrusor Overactivity. Journal of Neural Engineering, 8, Article ID: 036001.
[27] Winter, D.L. (1971) Receptor Characteristics and Conduction Velocities in Bladder Afferents. Journal of Psychiatric Research, 8, 225-235.
[28] Habler, H., Janig, W. and Koltzenburg, M. (1993) Myelinated Primary Afferents of the Sacral Spinal Cord Responding to Slow Filling and Distension of the Cat Urinary Bladder. The Journal of Physiology, 463, 449-460.
[29] Jezernik, S., Wen, J.G., Rijkhoff, N.J.M., Djurhuus, J.C. and Sinkjaer, T. (2000) Analysis of Bladder Related Nerve Cuff Electrode Recordings from Preganglionic Pelvic Nerve and Sacral Roots in Pigs. Journal of Urology, 163, 1309-1314.
[30] Jezernik, S., Grill, W.M. and Sinkjaer, T. (2001) Detection and Inhibition of Hyperreflexia-Like Bladder Contractions in the Cat by Sacral Nerve Root Recording and Electrical Stimulation. Neurourology and Urodynamics, 20, 215-230.<215::AID-NAU23>3.0.CO;2-0
[31] Kurstjens, G.A.M., Borau, A., Rodriguez, A., Rijkhoff, N.J.M. and Sinkjaer, T. (2005) Intraoperative Recordings of Electroneurographic Signals from Cuff Electrodes on Extradural Sacral Roots in Spinal Cord Injured Patients. Journal of Urology, 174, 1482-1487.
[32] Kurstjens, G.A.M., Rijkhoff, N.J.M., Borau, A., Rodriguez, A., Vidal, J. and Sinkjaer, T. (2005) Intraoperative Recordings of Sacral Root Nerve Signals in Humans. Artificial Organs, 29, 242-245.
[33] Wenzel, B.J., Boggs, J.W., Gustafson, K.J. and Grill, W.M. (2005) Detecting the Onset of Hyper-Reflexive Bladder Contractions from the Electrical Activity of the Pudendal Nerve. Transactions on Neural Systems Rehabilitation Engineering, 13, 428-435.
[34] Brindley, G.S. (1977) A Substitute for Hermeticity in Implantable Pressure Sensors. The Journal of Physiology, 272, 7P-8P.
[35] Brindley, G. and Donaldson, P. (1986) Electrolytic Current-Control Elements for Surgically Implanted Electrical Devices. Medical Biological Engineering Computing, 24, 439-441.
[36] Koldewijn, E.L., van Kerrebroeck, P.E.V., Schaafsma, E., Wijkstra, H., Debruyne, F.M.J. and Brindley, G. (1994) Bladder Pressure Sensors in an Animal Model. Journal of Urology, 151, 1379-1384.
[37] Takayama, K., Takei, M., Soejima, T. and Kumazawa, J. (1987) Continuous Monitoring of Bladder Pressure in Dogs in a Completely Physiological State. British Journal of Urology, 60, 428-432.
[38] Melgaard, J. and Rijkhoff, N.J. (2011) Detecting the Onset of Urinary Bladder Contractions Using an Implantable Pressure Sensor. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 19, 700-708.
[39] Greenland, J.E. and Brading, A.F. (1996) Urinary Bladder Blood Flow Changes during the Micturition Cycle in a Conscious Pig Model. Journal of Urology, 156, 1858-1861.
[40] Azadzoi, K.M., Pontari, M., Vlachiotis, J. and Siroky, M.B. (1996) Canine Bladder Blood Flow and Oxygenation: Changes Induced by Filling, Contraction and Outlet Obstruction. Journal of Urology, 155, 1459-1465.
[41] Farag, F.F., Martens, F.M., D’Hauwers, K.W., Feitz, W.F. and Heesakkers, J.P. (2011) Near-Infrared Spectroscopy: A Novel, Noninvasive, Diagnostic Method for Detrusor Overactivity in Patients with Overactive Bladder Symptoms—A Preliminary and Experimental Study. European Urology, 59, 757-762.
[42] Farag, F., Martens, F. and Heesakkers, J. (2010) 781 Application of Noninvasive Near Infra Red Spectroscopy in Diagnosis of Detrusor Overactivity. European Urology Supplements, 9, 251.
[43] Previnaire, J.G., Soler, J.M. and Hanson, P. (1993) Skin Potential Recordings during Cystometry in Spinal Cord Injured Patients. Paraplegia, 31, 13-21.
[44] Lindenthaler, W. (2007) Implantable Microphone for Treatment of Neurological Disorders.US 2007/0282317 A1.
[45] Upfal, J. and Roberts, A. (2004) Anatomical Sensor. WO/2004/037082.
[46] Opisso, E., Borau, A., Rodriguez, A., Hansen, J. and Rijkhoff, N. (2008) Patient Controlled versus Automatic Stimulation of Pudendal Nerve Afferents to Treat Neurogenic Detrusor Overactivity. Journal of Urology, 180, 1403.
[47] Martens, F.M.J., van Kuppevelt, H.J.M., Beekman, J.A.C., Rijkhoff, N.J.M. and Heesakkers, J.P.F.A. (2010) Limited Value of Bladder Sensation as a Trigger for Conditional Neurostimulation in Spinal Cord Injury Patients. Neurourology and Urodynamics, 29, 395-400.
[48] Ballaro, A., Mundy, A.R., Fry, C.H. and Craggs, M.D. (2003) Bladder Electrical Activity: The Elusive Electromyogram. BJU International, 92, 78-84.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.