in accordance with the present invention , there is provided an electronic stimulator implant for improving bladder voiding and preventing bladder hyperreflexia in a patient and which may eliminate detrusor - sphincter dyssynergia and hyperreflexia and maintain tonicity of the pelvic floor muscle of the bladder as shown in fig1 . fig2 illustrates an electronic stimulator implant for maintaining the bladder in accordance with the present invention , which is identified by reference numeral 10 . a tonicity signal generator 12 is contained in the electronic stimulator implant 10 . the tonicity signal generator 12 generates a tonicity signal which prevents bladder hyperreflexia by maintaining the tonicity of the pelvic floor muscle of the bladder , its effect on the reflex arc slows down contractions of the detrusor muscle which normally occurs in absence of feedback stimulation from the brain , thereby preventing hyperreflexia . a battery 13 is connected to the tonicity signal generator 12 , for providing power thereto . a voiding signal generator 14 is also contained in the electronic stimulator implant 10 . the voiding signal generator 14 generates a functional electrical stimulation ( fes ) signal to activate the bladder voiding process upon command . the voiding signal generator 14 generates a single signal which combines a first waveform of a low frequency and high amplitude , which activates contraction of the detrusor muscle , and a second waveform of a high frequency and low amplitude , which inhibits contraction of the external urethral sphincter of the bladder , thereby achieving bladder voiding without dyssynergia . an ac - dc voltage converter and regulator 15 is connected to the voiding signal generator 14 , for providing dc power thereto . a receiving coil 16 is connected to the power converter 15 . the coil 16 receives a power ac signal from coil 30 by inductance coupling . ac - dc voltage converter and regulator 15 rectifies and regulates a voltage signal . the command signal is modulated over the ac power signal by generator 28 . a command signal and feedback communications circuit 19 is connected to the coil 16 via regulator 15 . a modulated information signal generated by circuit 28 is detected , demodulated and decoded by circuit 19 . circuit 19 thus transmits a command signal to the tonicity signal generator 12 as will be explained hereinafter . while the voiding signal generator 14 can operate automatically when power is supplied by circuit 15 , preferably , circuit 19 supplies a command signal to turn on and off the voiding signal . likewise , circuit 19 is able to vary an impedance of coil 16 so that the variation of impedance can be detected by circuit 28 in order to communicate feedback data from the implant to the device 26 . the electrode - tissue contact impedance can be monitored either by generator 14 or by generator 12 . for example , the current flow to the electrode can be measured during the supply of the voiding signal , and this measured current value can be compared with stored values . the status of the contact impedance can be communicated to the device 26 and an indicator ( not shown ) connected to circuit 28 can indicate the status of the electrode - tissue contact . preferably , the impedance is measured using a voltage to frequency converter which converts the voltage at the electrode to a frequency . the frequency signal is then sampled over a time window and converted using a frequency counter circuit which outputs an 8 - bit word corresponding to the frequency , i . e . the measured voltage at the electrode . the measured voltage is related to the electrode - nerve impedance . the impedance to frequency conversion and the frequency to 8 - bit word conversion circuitry is also described in “ implantable measurement technique dedicated to the monitoring of electrode - nerve contact in bladder stimulators ”, med . biol . eng . comput ., 2000 , 38 , 465 - 468 , the content of which is hereby incorporated by reference . the impedance measurement is used firstly to adjust the amplitude of the signal generators 12 , 14 to ensure that the injected charge into the nerve remains constant over time for the tonicity and voiding signals . the impedance value ( i . e . the 8 - bit word ) is also communicated to the device 26 as mentioned above , using for example frequency modulation in the signal between the device 26 and the implant . outputs of tonicity and voiding signal generators 12 , 14 are connected through a selector 17 . the selective 17 normally allows the signal from generator 12 to pass through . upon command , the selector 17 is turned off to discontinue the tonicity signal when generator 14 operates . this is preferred , although not essential . a bipolar electrode has a first end 18 connected to the selector 17 and a second end 20 for connecting to a sacral nerve , such as the s 2 sacral segment . a cuff 22 is disposed at the second end 20 , for attachment to the sacral nerve . the cuff 22 is preferably made of a shape memory alloy ( sma ) and isolated by silastic , which is cooled to open before and during placement on the nerve . the cuff 22 then warms up to body temperature and elastically grasps the nerve firmly with the exact desired pressure . the electrode comprises two teflon ™ coated stainless steel wires connected to platinum contacts having a 25 μm thickness . the contacts are separated in the axial direction of the nerve by about 1 to 2 mm , and molded in an elastomeric envelope made of silastic and provide the electrical connection to the nerve . various methods of wrapping the contacts around the nerve can be used , although the sma cuff electrode is preferred . the electronic stimulator implant 10 is activated by an external controller 26 . the external controller 26 contains a power generator 28 . a transmitting coil 30 is mounted to the power generator 28 . a batter 32 is connected to the power generator 28 , for providing power thereto . a switch 34 is connected to the power generator 28 , to allow the patient to manually activate the power generator 28 . upon activation of the switch 34 , the power generator 28 provides power to the voiding signal generator 14 using electromagnetic coupling between the transmitting coil 30 and the receiving coil 16 of the implant 10 . the transmitting coil 30 establishes an electromagnetic ac coupling with the receiving coil 16 of the implant 10 when in proximity thereof , for supplying power thereto and for transmitting a control signal to the implant 10 . however other coupling techniques may be used in addition to radio - frequency magnetic inductance coupling , such as an optical receiver and infrared . a versatile version of the controller includes a keyboard , display , and allows all stimuli parameters to be programmed . the external controller used for programming stimuli parameters is thus preferably a more sophisticated controller than unit 26 , the latter being used by the patient . a processing unit 36 is contained in the external controller 26 and connected to the power generator 28 . the control signal from the power generator 28 sets the needed parameters , such as frequency and / or amplitude of the voiding signal , and determines a continuous or intermittent mode for the tonicity signal . the control signal generated by the processing unit 36 of the external controller 26 is received by the voiding signal generator 14 ( via circuit 19 ). fig4 illustrates the waveforms generated by the tonicity signal generator 12 ( below ) compared to the waveform generated by the voiding signal generator 14 ( above ). in the waveform generated by the voiding signal generator 14 , lfa corresponds to the low frequency amplitude . lfw to the low frequency pulse width , lfp to the low frequency period , hfa to the high frequency amplitude , hfw to the high frequency pulse width and hfp to the high frequency period . the high frequency signal amplitude may vary from 0 to 3 ma and the pulse width of the high frequency signal from 10 to 900 μsec . the amplitude of the tonicity signal is about 25 % to 50 % of the amplitude of the voiding signal . the lower power level required makes it practical to use a self - contained power source such as battery 13 for powering the first signal generator 12 . through a surgical procedure , the implant 10 is inserted in a subcutaneous pouch in proximity of the surface of the skin of a patient , while an electrode is superficially inserted in the subcutaneous space . the second end of the electrode 20 thereof is connected to the sacral root via the cuff 22 . the implant 10 generates continually or intermittently the tonicity signal , to maintain a basic stimulation of the external urethral sphincter and the pelvic floor muscle . the tonicty signal requires a minimum of energy from the battery 13 in the implant 10 . to activate bladder voiding , the patient holds the external controller 26 and puts it close to the skin area of the body covering the implant 10 . the patient then activates the manual switch 34 of the external controller 26 . a control signal is generated by the processing unit 36 of the external controller 26 , which is transmitted by radiofrequency electromagnetic coupling from the transmitting coil 30 to the receiving coil 16 in the implant 10 . upon receiving the control signal , the voiding signal generator generates a combined fes waveform as described above , which is transmitted through the electrode 22 to the sacral nerve . the high - frequency waveform of the voiding signal inhibits the somatic fibers innervating of the external urethral sphincter of the bladder while leaving the detrusor muscle thereof free to be stimulated by the low - frequency waveform , thereby voiding the bladder . the voiding signal generator 14 can be provided by an fpga . the generator can be provided by a low - power consumption microcontroller , such as the microchip ™ pic based on a surface mount component , and both generator circuits can be provided by an optimized dedicated full custom integrated circuit ( ic ) device . preferably , a single application specific integrated circuit ( asic ) is used for providing the two signal generator functions with minimal power consumption . while the invention has been described with particular reference to the illustrated embodiment , it will be understood that numerous modifications thereto will appear to those skilled in the art . accordingly , the above description and accompanying drawings should be taken as illustrative of the invention and not in a limiting sense .
the present invention relates to lower urinary dysfunctions and more particularly to an electronic stimulator implant and method to improve bladder voiding and prevent bladder hyperreflexia . there is provided an electronic stimulator implant for which comprises a tonicity signal generator generating a tonicity signal which prevents bladder hyperreflexia combined with a voiding signal generator generating a voiding signal for voiding the bladder . the implant is connected to an end of an electrode , and the second end thereof is connected to a sacral nerve . when the voiding key is activated , the voiding signal is generated which activates detrusor muscle contraction , causing bladder voiding . the voiding may be achieved without dyssynergia , by activating detrusor muscle contraction without activating external urethral sphincter contraction . the tonicity signal may be provided intermittently . the implant may be activated by a manually activated external controller .