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Urology. 2019 Sep 17. pii: S0090-4295(19)30802-7. doi: 10.1016/j.urology.2019.08.046. [Epub ahead of print]

RADIOFREQUENCY-BASED BLADDER DENERVATION DEVICE.

Author information

1
Department of Urology, University of California, Irvine. Electronic address: zokhunov@uci.edu.
2
California Institute of Technology (CalIT2), University of California, Irvine.
3
Department of Urology, University of California, Irvine.
4
Department of Pathology, University of California, Irvine.
5
Department of Pathology, Duke University, North Carolina.

Abstract

OBJECTIVES:

To determine if targeted and modulated radiofrequency ablation (RFA) of the urinary bladder using our novel ablation device (Denerblate) reduces bladder nerve density, potentially leading to a novel strategy for the management of overactive bladder.

METHODS:

Fifteen pigs were divided into four groups: control (n=3), 1-week (n=4), 4-week (n=4) and 12-week (n=4) survival times. Denerblate was deployed on the trigone area of the bladder. Three 240-second cycles of modulated RFA were applied with 30 seconds between cycles. At the end of each survival term, urinary bladders were harvested for histopathological evaluation. Nerve count and density were manually calculated.

RESULTS:

All procedures were successfully completed, and all animals survived to the desired time points. Mean nerve density (nerves/mm2) was highest in the control and 1-week survival group compared to the 4-week and 12-week groups, both of which demonstrated significant diminishment. Nerve density in the bladder neck at control, 1 week, 4 weeks and 12 weeks were 1.8, 1.35, 0.87 and 0.12, respectively (p<0.001). Nerve density in the bladder trigone area at control, 1 week, 4 weeks and 12 weeks were 1.5, 0.98, 0.65 and 0.112, respectively (p<0.001). Epithelial heat injury was observed in 14.3% at 1 week, 10.7% at 4 weeks, but completely resolved by 12-weeks.

CONCLUSIONS:

In the porcine model, modulated RFA delivered by our novel device reduced nerve density in the bladder neck and trigone by 88.6% and 88.9% at 12 weeks without evidence of lasting epithelial injury.

KEYWORDS:

detrusor; engineering; overactive bladder; radiofrequency ablation; trigone

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