"Listening directly to the nerves" — personalized stimulation control mechanism for urinary disorder treatment (tibial nerve stimulation)

Urinary and bowel disorders, manifesting as symptoms like frequent urination or difficulty in bowel movements, can greatly impact one’s quality of life, even though they are not outwardly visible. While many people dismiss these symptoms as trivial or feel embarrassed to seek help, they may indicate serious neurological conditions that require early diagnosis and continuous, specialized management.

Recently, a research team in Korea has proposed a neuromodulation control technique enabling more accurate and effective treatment, and demonstrated its efficacy through tibial nerve stimulation for urinary disorders, drawing significant attention. Their findings were published in the prestigious scientific journal Nature Communications on May 2, 2025.

  Overactive bladder (OAB) syndrome includes a range of symptoms such as frequent urination, sudden urges to urinate, and difficulty initiating urination. These symptoms span from mild conditions like urinary incontinence to severe urinary dysfunction, particularly common among the elderly.

Among the emerging treatments for urinary disorders, neuromodulation therapy is gaining prominence. This method involves delivering fine electrical stimulation to specific nerves that regulate bladder function to help alleviate symptoms. However, traditional treatments rely heavily on the clinician’s experience and patient's subjective feedback to adjust stimulation parameters, leading to inconsistent outcomes.

The joint research team from POSTECH and Hanyang University developed a technique to directly measure the nerve’s response to therapeutic electrical stimulation in real-time. The core of this approach is the use of the Evoked Compound Action Potential (ECAP), a type of bioelectrical signal. In simple terms, it functions like a conductor tuning an orchestra’s tempo by listening closely to subtle changes in sound; here, the nerve's reaction is captured and used to precisely adjust the stimulation. This enables truly personalized stimulation based on each patient's individual nerve responses.

To implement this system, the team developed a compact implantable device featuring specialized electrodes. When applied to animal models with OAB symptoms, the system effectively alleviated OAB symptoms. Unlike previous methods that adjusted stimulation by visually observing physical responses like foot twitches, the new technology directly measures nerve signals, allowing for more precise control.

Most notably, this technology offers personalized treatment tailored to each patient's neural condition. Rather than relying on empirical adjustments by clinicians, the stimulation intensity is automatically optimized in real-time based on direct feedback from the patient's own nerves.

Professor Sung-Min Park from POSTECH highlighted the significance of this breakthrough, stating, "This is a highly practical technology that can help patients with urinary and bowel disorders live more independent and healthier lives." He also shared insights from his experience at Medtronic, a leading global medical device company, where he contributed to the development of implantable pacemakers compatible with MRI environments, strengthening his expertise in neuromodulation and implantable medical devices. "Since ECAP signals can be easily measured from most peripheral nerves," he added, "we expect this technology to be widely applicable not only for urinary disorders but also for various chronic neurological conditions." He further noted, "Given the growing interest in neuromodulation across the medical field, the clinical potential of this technology is very high."

This research was supported by the National R&D Program, the Pioneer Research Center Program, and the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by Ministry of Science and ICT.