title: Real-Time Classification of Bladder Events for Effective Diagnosis and Treatment of Urinary Incontinence.
abstract: Diagnosis of lower urinary tract dysfunction with urodynamics has historically relied on data acquired from multiple sensors using nonphysiologically fast cystometric filling. In addition, state-of-the-art neuromodulation approaches to restore bladder function could benefit from a bladder sensor for closed-loop control, but a practical sensor and automated data analysis are not available. We have developed an algorithm for real-time bladder event detection based on a single in situ sensor, making it attractive for both extended ambulatory bladder monitoring and closed-loop control of stimulation systems for diagnosis and treatment of bladder overactivity. Using bladder pressure data acquired from 14 human subjects with neurogenic bladder, we developed context-aware thresholding, a novel, parameterized, user-tunable algorithmic framework capable of real-time classification of bladder events, such as detrusor contractions, from single-sensor bladder pressure data. We compare six event detection algorithms with both single-sensor and two-sensor systems using a metric termed Conditional Stimulation Score, which ranks algorithms based on projected stimulation efficacy and efficiency. We demonstrate that adaptive methods are more robust against day-to-day variations than static thresholding, improving sensitivity and specificity without parameter modifications. Relative to other methods, context-aware thresholding is fast, robust, highly accurate, noise-tolerant, and amenable to energy-efficient hardware implementation, which is important for mapping to an implant device.
authors: Robert
authors: R
authors: Karam
authors: Dennis
authors: D
authors: Bourbeau
authors: Steve
authors: S
authors: Majerus
authors: Iryna
authors: I
authors: Makovey
authors: Howard B
authors: HB
authors: Goldman
authors: Margot S
authors: MS
authors: Damaser
authors: Swarup
authors: S
authors: Bhunia
mesh_terms: D004724:Endoscopy / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D012371:Robotics / Q000295:instrumentation*; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation*; D001743:Urinary Bladder / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000503:physiopathology*