CONTINENT RECONSTRUCTION OF DETRUSOR HYPERREFLEXIA BY SACRAL BLADDER DENERVATION COMBINED WITH CONTINENT VESICOSTOMY

We describe a two-stage surgical procedure for complex hyperreflexic d etrusor dysfunction refractory to conservative therapy. First, ventral and dorsal sacral rhizotomies (S2 to S4/5) are performed to restore v esical storage function and abolish autonomic dysreflexia. Then, after an interval of several weeks-to-allow for detrusor relaxation, contin ent vesicostomy is performed for suprapubic clean intermittent cathete rization. The procedure is effective both objectively and subjectively , is only moderately invasive, and requires neither sophisticated nor expensive medical equipment.