REDUCTION OF DETRUSOR-SPHINCTER DYSSYNERG IA DURING VENTRAL SACRAL ROOT STIMULATION - ANATOMICAL AND ELECTROPHYSIOLOGICAL EXPERIMENTS

Over the last decade, different models for sacral deafferentation and ventral sacral root stimulation for treatment of detrusor hyperreflexi a have been developed. In respect to the clinical experience gained un til now, we investigated the significance of site of deafferentation a nd electrode implantation and new techniques to reduce detrusor-sphinc ter dyssynergia during electrically stimulated micturition. Our result s indicate that intradural deafferentation combined with extradural el ectrode implantation offers maximal efficiency of deafferentation with minimal surgical risk. Detrusor-sphincter dyssynergia can be reduced firstly by use of tripolar instead of monopolar electrodes (confirmati on of results of G. S. Brindley) and secondly by selective division of ventral sacral rootlets innervating the continence mechanism.