Study on Preliminary Safety and Efficacy of Epidural Electrical Stimulation to Manage Lower Urinary Tract Dysfunction After Spinal Cord Injury (ReeVoid)

July 9, 2025 updated by: Jocelyne Bloch, Ecole Polytechnique Fédérale de Lausanne
This clinical trial aims to assess the preliminary safety and efficacy of Epidural Electrical Stimulation (EES) therapy in managing lower urinary tract dysfunction in individuals with sub-acute or chronic spinal cord injury (SCI). The study evaluates the therapy's potential to improve urinary function and prevent neurogenic detrusor overactivity, ultimately seeking to enhance quality of life for individuals with SCI.

Study Overview

Detailed Description

The consequences of a Spinal Cord Injury (SCI) are dramatic. SCI leads to impairment of motor, sensory, and autonomic systems, dysregulating almost every bodily function below the level of injury. The majority of research on SCI focuses on the restoration of movement. However, the disruption of pathways controlling the bladder leads to less-appreciated symptoms that require life-long clinical management, are the one of the main cause of rehospitalization, and incurred the largest healthcare costs after SCI. Neurogenic bladder issues, such as neurogenic detrusor overactivity (NDO) leading to incontinence, detrusor-sphincter dyssynergia (DSD) and decreased bladder compliance, are currently treated with intermittent catheterization, anticholinergic medications, botulinum toxin injections directly into the detrusor and ultimately irreversible major surgical interventions. Despite improvement in bladder management provided by these clinical and interventional tools, people with SCI still experience recurrent urinary tract infections from repeated catheterization, incontinence events impacting their professional and intimate life, side-effects from anti-cholinergic medication. It therefore comes as no surprise that people with spinal cord injury prioritize the treatment of lower urinary tract dysfunction as one of their top health priorities.

The investigators reasoned that the neuroprosthetic management of micturition and urinary continence may overcome many of the existing limitations of current clinical management strategies. To test this idea, the investigators have developed a neuroprosthetic system based on Epidural Electrical Stimulation (EES) of the spinal cord that restored micturition (EESVOIDING) and improve urinary continence by reducing detrusor overactivity (EESSTORAGE) in preclinical models of SCI. Development of this neuroprosthetic system combined with rigorous experiments led to the identification of the locations and parameters of EES that can activate the detrusor while relaxing the external urethral sphincter (EUS). The investigators also gathered preliminary evidence on the key features of this therapeutic strategy in one patient with low-thoracic motor-complete SCI (T10, AIS-B) who was implanted with a neuroprosthetic system on the lumbosacral spinal cord (covering T12 to S1) to restore walking (STIMO clinical Trial, NCT02936453). Stimulation of the sacral spinal cord of this participant resulted in controlled detrusor contraction leading to voiding. Consequently, the investigators hypothesize that EES has the potential to become the first-line treatment for bladder dysfunction in people with chronic or sub-acute SCI. However, its clinical deployment relies on selective stimulation paradigms and development of medical-grade implantable spinal-cord stimulation technologies that are optimized for bladder management.

The ReeVoid clinical study will enroll 3 participants, who will be implanted with a system to apply EES to stimulate the spinal circuits involved in the control of the bladder. The aim of the study is to manage lower urinary tract functions with EES, including supporting voiding and preventing neurogenic detrusor overactivity incontinence (NDOI) in individuals with sub-acute or chronic spinal cord injury located above T11 and who suffer from lower urinary tract dysfunction. Two electrode paddle leads will be implanted. The first one will cover the dorsal root entry zone of the lumbosacral segments (L4-S5), while the second will aim to target the S1-S4 roots where they exit the spinal canal in the lower vertebras, and thus to maximise selective recruitment of the dorsal roots involved in the control of the detrusor and urethral sphincter muscles. Each paddle lead will be connected to a neurostimulator located subcutaneously in the region of the abdomen.

This therapy aims also to have a positive impact on other neurological functions such as sexual function, bowel management and muscle tone normalization (reduced spasticity).

Study Type

Interventional

Enrollment (Estimated)

3

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

    • Vaud
      • Lausanne, Vaud, Switzerland, 1011
        • Recruiting
        • Centre Hospitalier Universitaire Vaudois (CHUV)
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age 18 or older;
  • Must provide and sign the Informed Consent Form prior to any study-related procedures;
  • Spinal cord injury lesion level above T11 (inclusive);
  • SCI graded as AIS- B, C or D;
  • SCI ≥ 6 months;
  • Confirmed lower urinary tract dysfunction during urodynamic assessment (NDO, DSD);
  • Intolerant, refractory or inefficient to conservative treatment options such as medications and behavioural management;
  • Using intermittent self-catheterization;
  • Stable medical, physical and psychological condition as considered by the investigators;
  • Able to understand and interact with the study team in French or English;
  • Agrees to comply in good faith with all conditions of the study and to attend all scheduled appointments;

Exclusion Criteria:

  • Botulinum toxin vesical injections in the previous 6 months;
  • Presence of non-pharmacological treatments for lower urinary tract dysfunction (e.g. sacral nerve stimulation);
  • Does have or needs a suprapubic catheter or bladder indwelling catheter;
  • Presence of upper urinary tract dilatation or bladder or renal stones;
  • Presence of urethral stricture or significant benign prostate hyperplasia;
  • Presence of significant pressure ulcers;
  • Previous lower urinary tract surgery;
  • Presence of Autonomic Dysreflexia during urodynamic test;
  • Recurrent and symptomatic urinary tract infection (more than 3 per year);
  • Presence of intrathecal baclofen pump;
  • Diseases and conditions that would increase the morbidity and mortality of spinal surgery;
  • Other clinically significant concomitant disease states (e.g., syringomyelia, bladder cancer, renal failure, hepatic dysfunction, cardiovascular disease, etc.);
  • The inability to withhold antiplatelet/anticoagulation agents perioperatively;
  • Presence of pacemakers for cardiac conditions;
  • Other conditions that would make the subject unable to participate in testing in the judgement of the investigators;
  • Women who are pregnant (pregnancy test obligatory for woman of childbearing potential) or breast feeding;
  • Lack of acceptable or highly effective method of contraception for women of childbearing capacity;
  • Intention to become pregnant during the course of the study;
  • Inability to follow the procedures of the study, e.g. due to language problems, mental illness, psychological disorders, or dementia of the participant;
  • Participation in another study with investigational drug or device within the 30 days preceding and during the present study;
  • Have any indication that would require Magnetic Resonance Imaging (MRI)
  • Is the investigator himself, his/her family members, employees or other dependent persons.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: All participants
All participants enrolled in the study will receive the same intervention. This clinical trial evaluates a novel therapy using a CE-marked medical device employed off-label. Participants will undergo implantation of a neurostimulation system designed to deliver electrical stimulation to the spinal cord. The therapy aims to improve control over detrusor and urethral sphincter muscles by targeting the associated nerves.
Two Boston Scientific WaveWriter Alpha™ Implantable Pulse Generators (IPGs) will be implanted and connected to CoverEdge™ or CoverEdge™ X 32 Surgical Paddle Leads. The leads are positioned to enable targeted stimulation of the spinal cord to optimize control of urinary functions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Occurrence of serious adverse events and adverse events.
Time Frame: From enrolment through study completion, an average of 10 months.
Occurrence of serious adverse events and adverse events that are deemed related or possibly related to the use of the investigational.
From enrolment through study completion, an average of 10 months.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
ASIA impairment scale - International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)
Time Frame: Pre-implantation (up to 3 weeks pre-implantation) and at the End of Study phase (lasting up to 1 week at 9 months)
Clinical examination used to assess the motor and sensory impairment and severity of a spinal cord injury.
Pre-implantation (up to 3 weeks pre-implantation) and at the End of Study phase (lasting up to 1 week at 9 months)
Spasticity assessment (Modified Ashworth Scale - MAS)
Time Frame: Pre-implantation (up to 2 weeks pre-implantation) and at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Resistance of a muscle to a passive range of motion about a single joint, measured using the Modified Ashworth Scale (MAS), a 6-point scale with scores of 0, 1, 1+, 2, 3, and 4. A score of 0 indicates no increase in muscle tone, while a score of 4 indicates the affected part is rigid in flexion or extension. Higher scores indicate worse spasticity.
Pre-implantation (up to 2 weeks pre-implantation) and at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Daily Bladder related diary
Time Frame: Pre-implantation (up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3 and 6 post-implantation and lasting up to 1 week)
Self-reported measures including urinary related events (voiding volume by catheterization and electrical stimulation, frequency, daytime and during night frequency, catheterization and volume of residual volume after stimulation, symptomatic urinary tract infection, use of stimulation) reported on a tracking app to quantify changes before and after implantation.
Pre-implantation (up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3 and 6 post-implantation and lasting up to 1 week)
Renal ultrasound
Time Frame: Pre-implantation (up to 3 weeks before implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Renal ultrasound is used to monitor the kidneys, ureters, and bladder, providing valuable information about kidney size, shape, and position.
Pre-implantation (up to 3 weeks before implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Urine sampling
Time Frame: Pre-implantation (up to 3 weeks pre-implantation) and upon suspicion
Urine sampling is taken to confirm the absence of any urinary tract.
Pre-implantation (up to 3 weeks pre-implantation) and upon suspicion
24 hours urine collection
Time Frame: Pre-implantation (up to 3 weeks pre-implantation) and at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
24 hours urine collection is taken to quantify the spot albumin and creatinine in the urine. These parameters are used to confirm the absence of any renal dysfunctions.
Pre-implantation (up to 3 weeks pre-implantation) and at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Blood samples
Time Frame: Pre-implantation (up to 3 weeks pre-implantation) and at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Blood sampling (max 20mL) is taken to quantify creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and cystatin C. These parameters are used to confirm the absence of any renal dysfunctions.
Pre-implantation (up to 3 weeks pre-implantation) and at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Cystometry
Time Frame: Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
A catheter is inserted into the bladder to measure intravesical pressure while the bladder is filled with sterile fluid at a controlled rate. Simultaneously, abdominal pressure is monitored to assess detrusor pressure and bladder compliance. Cystometry helps identify neurogenic detrusor overactivity, bladder capacity, and compliance.
Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Imaging (with contrast agent)
Time Frame: Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
X-Ray (or fluoroscopy) can be taken, with imaging contrast agents, to provide visualization of the urinary tract and/or catheter placements (optional).
Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Pressure-flow study
Time Frame: Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
During voiding, simultaneous measurements of detrusor pressure and urinary flow rate are recorded. This aids in diagnosing detrusor-sphincter dyssynergia (DSD), evaluating voiding efficiency, and identifying obstructive patterns.
Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Electromyography (EMG)
Time Frame: Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Surface electrodes or specialized catheters are used to record electrical activity in the bladder and external urethral sphincter muscles. EMG helps detect detrusor-sphincter dyssynergia (DSD) by assessing the coordination between detrusor and sphincter activity during filling and voiding.
Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
Flowmetry - Urethral pressure profile (UPP)
Time Frame: Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)
A catheter-mounted pressure sensor is withdrawn slowly from the bladder through the urethra, recording pressure changes along the urethral length. UPP assists in evaluating sphincter function and diagnosing urethral obstruction.
Pre-implantation (up to 3 weeks and up to 2 weeks pre-implantation), Mapping phase (1 week post-implantation and lasting up to 1 month), at Follow-up phase and End of Study phase (at months 3, 6 and 9 post-implantation and lasting up to 1 week)

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
NBDS (Neurogenic Bowel Dysfunction Score)
Time Frame: Pre-implantation (up to 2 weeks pre-implantation) and monthly for 9 months post-implantation
10-item questionnaire that is associated with impaired QoL caused by bowel symptoms. The NBD weighted score ranges between 0 and 47 points. A higher overall NBD score indicates more severe bowel symptoms.
Pre-implantation (up to 2 weeks pre-implantation) and monthly for 9 months post-implantation
NBSS (Neurogenic Bladder Symptom Score)
Time Frame: Pre-implantation (up to 2 weeks pre-implantation) and monthly for 9 months post-implantation
The NBSS consists of 24 items across three domains: Incontinence (scored 0-29); Storage and Voiding (scored 0-22); and Consequences (scored 0-23). For all domains, a higher score represents a worse symptom burden or QoL (quality of life).
Pre-implantation (up to 2 weeks pre-implantation) and monthly for 9 months post-implantation
SF-Qualiveen (QUALIVEEN Short Form)
Time Frame: Pre-implantation (up to 2 weeks pre-implantation) and monthly for 9 months post-implantation
To assess health-related quality of life of patients with urinary disorders in neurologic conditions. The 8-item questionnaire include bother with limitations (2 items), frequency of limitations (2 items), fears (2 items), and feelings (2 items). Items 1-6 are scored on a 5-point scale (0 to 4), with higher scores indicating a greater negative impact on quality of life. Items 7-8 are scored on a 5-point reverse scale (0 to 4), where higher scores indicate less impact on quality of life.
Pre-implantation (up to 2 weeks pre-implantation) and monthly for 9 months post-implantation
IIEF/FSFI (International Index of Erectile Function-5/Female Sexual Function Index)
Time Frame: Pre-implantation (up to 2 weeks pre-implantation) and monthly for 9 months post-implantation

IIEF-15: A 15-item questionnaire covering five domains: erectile function (6 items), orgasmic function (2 items), sexual desire (2 items), intercourse satisfaction (3 items), and overall satisfaction (2 items). Scores range from 5 to 25, with erectile dysfunction (ED) classified as severe (5-7), moderate (8-11), mild to moderate (12-16), mild (17-21), and no ED (22-25). Higher scores indicate better erectile function.

FSFI: A 19-item self-reported measure assessing six domains: desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Each item is scored on a 5-point scale (1 to 5), with higher scores indicating better sexual function.

Pre-implantation (up to 2 weeks pre-implantation) and monthly for 9 months post-implantation
ADFSCI (Autonomic Dysreflexia following SCI)
Time Frame: Pre-implantation (up to 3 weeks pre-implantation) and monthly for 9 months post-implantation
The ADFSCI is a 24-item questionnaire consisting of four parts: demographics, medication, AD (Autonomic Dysreflexia) and hypotension. The AD section (10 items) and hypotension section (7 items) assess the severity and frequency of hyper- or hypotensive symptoms, such as headache, goosebumps, dizziness, and light-headedness, in different circumstances. Each item is scored on a 5-point scale (0 to 4), with higher scores indicating greater severity and frequency of symptoms.
Pre-implantation (up to 3 weeks pre-implantation) and monthly for 9 months post-implantation

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Jocelyne Bloch, MD, Centre Hospitalier Universitaire Vaudois (CHUV)

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 10, 2025

Primary Completion (Estimated)

February 1, 2027

Study Completion (Estimated)

February 1, 2027

Study Registration Dates

First Submitted

January 28, 2025

First Submitted That Met QC Criteria

February 20, 2025

First Posted (Actual)

February 25, 2025

Study Record Updates

Last Update Posted (Actual)

July 14, 2025

Last Update Submitted That Met QC Criteria

July 9, 2025

Last Verified

July 1, 2025

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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