Systems and methods for improved treatment of overactive bladder

Abstract

Methods and systems for providing therapy related to urological disorders. Particular embodiments of this technology relate to stimulation of lumbar spinal targets either alone or in combination with a sacral target. In embodiments spinal roots are stimulated by partially or fully implanted stimulators to treat symptoms by producing bladder excitation or inhibition relative to that which occurs prior to stimulation. Embodiments also disclose improving nerve stimulation, including lumbar nerve root stimulation, using systems and methods termed enhanced transcutaneous electrical stimulation (eTENS) since these enhance the excitation of neural tissue.

What is claimed is: 
     
         1 . A system configured to treat a patient suffering from symptoms of overactive bladder comprising:
 at least one stimulator implanted in a patient and configured to stimulate at least a first spinal nerve root target selected from the nerve group of: L2, L3 and L4; and,   an implanted neurostimulator having at least one stimulation protocol configured to apply at least a first stimulation signal including a frequency of between 2 and 50 Hz to at least the first spinal nerve root target to modulate bladder activity.   
     
     
         2 . The system of  claim 1  wherein the at least one stimulation protocol includes a first stimulation protocol having parameters to provide inhibition of bladder activity and a second stimulation protocol having parameters to provide excitation of bladder activity. 
     
     
         3 . The system of  claim 2  wherein the first and second stimulation protocols define stimulation signals with different frequencies and/or amplitudes. 
     
     
         4 . The system of  claim 1  wherein the first stimulation signal is selected to have a frequency and amplitude which produces at least bladder activity inhibition in the patient. 
     
     
         5 . The system of  claim 1  wherein the first stimulation signal is selected to have a frequency and amplitude which produces at least bladder activity excitation in the patient. 
     
     
         6 . The system of  claim 1  in which the first target is selected to be a target that has been previously assessed as producing therapeutic efficacy in the patient. 
     
     
         7 . The system of  claim 1  further including a second stimulator that is selected to stimulate a second nerve root target from the nerve group. 
     
     
         8 . The system of  claim 7  further including a third stimulator that is selected to stimulate a third nerve root target from a nerve group. 
     
     
         9 . The system of  claim 1  wherein the nerve root target is L2. 
     
     
         10 . The system of  claim 1  wherein the nerve root target is L3. 
     
     
         11 . The system of  claim 1  wherein the nerve root target is L4. 
     
     
         12 . The system of  claim 1  in which the at least first stimulation signal includes a first signal and second signal selected to be signals that have been assessed to produce desired modulation of bladder activity in the patient when presented in combination. 
     
     
         13 . The system of  claim 1  in which the at least first stimulation signal includes a first signal and second signal selected to be signals that have been shown to produce increased therapeutic efficacy in the patient when presented together compared to the efficacy of either signal presented alone. 
     
     
         14 . The system of  claim 1  in which the at least first stimulation signal includes a first signal and second signal selected to be presented in at least one of the following manners (1) at the same time, at different times, (2) in an alternating manner, (3) continuously, (4) periodically, for at least a pre-determined duration each day (5) at pre-determined time(s) of the day, (6) while the patient is sleeping (7) upon patient request, and, (8) due to data sensed by a sensor. 
     
     
         15 . The system of  claim 1  further including a second stimulator implanted in a patient and configured to stimulate a second spinal nerve target selected from the group of: L5, S1, S2, S3, and S4. 
     
     
         16 . The system of  claim 1  further including a second stimulator implanted in a patient and configured to stimulate a second spinal nerve target which is S3. 
     
     
         17 . The system of  claim 1  wherein the patient is selected to be a patient suffering from symptoms of overactive bladder who has been shown to be refractory to stimulation of S3 alone. 
     
     
         18 . The system of  claim 15  wherein the signals applied to the first and second stimulator are independently set by the stimulation protocol. 
     
     
         19 . The system of  claim 15  signal used at the first and second stimulator are selected to be signals that have been assessed to produce therapeutic efficacy in the patient when presented in combination. 
     
     
         20 . The system of  claim 15  signal used at the first and second stimulator are selected to be signals that have been assessed to produce therapeutic efficacy in the patient when presented in combination compared to the efficacy of the first modulation signal or the second modulation signal when presented alone.