DURHAM, N.C. — Duke University biomedical engineering researchers have moved a step closer to a “smart bladder pacemaker” that might one day restore bladder control in patients with spinal cord injury or neurological disease.

The team’s latest findings show that a device that taps into the urinary “circuit” in the spinal cord could selectively coordinate the contraction and release of muscles required for maintaining continence.

Warren Grill of Duke’s Pratt School of Engineering and his colleagues have shown in cats that electrical stimulation can engage the spinal circuitry to effectively empty the bladder, while delivery of lower frequency pulses to the same nerve can significantly increase bladder capacity and improve continence.

Manipulating the nervous system provides a more flexible way of influencing urinary function than would direct bladder stimulation, Grill said.

“Stimulating the bladder directly can cause it only to contract, not to keep it from contracting,” Grill said. “We stimulate the sensory inputs in the spinal cord to orchestrate either the inhibition or activation of urination.

“This illustrates an important principle: we can use the ‘smarts’ of the nervous system to orchestrate control of complex functions,” he said.

A similar approach might also have potential for stimulating the spinal reflexes that control locomotion, Grill added. Other investigators are testing such a system for use in physical therapy for people suffering from some form of paralysis, to help them learn to walk again.

The team now is working with Duke University Medical Center researchers on a clinical feasibility study to examine the urinary reflexes of human patients with spinal cord injuries.

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