ADJUVANT DRUG-THERAPY - A REVIEW OF 30 CASES OF SACRAL ANTERIOR ROOT STIMULATOR

Implantation of a sacral anterior root stimulator in spinal cord injur ed patients must achieve two main goals to maintain a vesicosphinctera l balance: complete bladder voiding and correct continence. During the postoperative period, difficulties may arise or persist with either a n incontinence due to an insufficient deafferentation with bladder hyp erreflexia or an incomplete voiding because of an insufficient contrac tion of detrusor and/or too high urethral resistances (vesicosphincter al dyssynergia). A third of our patients required specific therapies a fter implantation to promote interstimulation continence and complete bladder voiding. Regarding continence, adjuvant therapies are effectiv e for bladder hyperreflexia in connection with a too-partial deafferen tation. On the other hand, these therapies have little effect on low b ladder compliance. In regard to bladder voiding, nonsurgical treatment s are equally effective. These treatments (parasphincteral infiltratio ns, alpha-blockers) must not be permanent, but allow a reharmonizing b etween expulsive strengths and urethral resistances. Eighty percent of our patients who required adjuvant therapies have been improved signi ficantly. This confirms the efficiency of adjuvant therapy and speaks for patience.