FUNCTIONAL REHABILITATION OF THE NEUROGENIC BLADDER BY CHRONIC SACRALNEUROMODULATION

To assess the value of sacral neuromodulation for treatment of neuroge nic bladder dysfunction, 27 patients (19 women, 8 men; mean age 44.9 y ears) underwent acute and subchronic testing before chronic electrode implantation on a dorsal 53 foramen. Fifteen patients had urgency/freq uency owing to detrusor hyperreflexia and/or bladder hypersensitivity, 11 had urinary retention owing to detrusor areflexia, and 1 had combi ned bladder hypersensitivity and detrusor areflexia. Twelve patients ( 11 women and 1 man) underwent chronic neurostimulation. Mean follow-up evaluation, by voiding diary and repeated urodynamics, was 17 months (4-35 months). Severe side effects were encountered in 2 patients in w hom the implant had to be removed (1 with infection, 1 with adverse se nsation during stimulation), minor and tolerable side effects in anoth er 3 patients. In 8 patients the urologic sequelae of the neurologic d isorder were alleviated significantly (50% or more), in 5 of them chro nic neuromodulation was as effective as preoperative testing. Chronic sacral neuromodulation can be valuable for treating neurogenic bladder dysfunction. However, preoperative evaluation and surgical techniques must be further refined to achieve long-term results that are at leas t as effective as those of preoperative testing.