Bilateral S3 nerve stimulation, a minimally invasive alternative treatmentfor postoperative stress incontinence after implantation of an anterior root stimulator with posterior rhizotomy: a preliminary observation

Study design: A preliminary report. Objectives: Urinary stress incontinence following implantation of an anteri or root stimulator and a posterior rhizotomy is a rare complication which i s difficult to treat, It is seen in patients with an open bladder neck (T9- L2 lesion). An artificial urinary sphincter is a possible treatment for thi s condition but has a higher failure rate in patients with neurogenic bladd er disease and could complicate micturition. Setting: Ghent, Belgium. Methods: A male paraplegic patient (T9, complete lesion) aged 36 was suffer ing from severe urinary incontinence due to detrusor hyperreflexia. Preoper atively the bladder neck was closed on cystography. Following implantation (6/95) of an intradural anterior root stimulator with posterior rhizotomy, severe urinary stress incontinence presented. Bilateral S3 foramen leads we re implanted and connected to a pulse generator. Results: The patient has been continent with continuous stimulation of both S3 roots for 4 years, and no fatigue of the levator muscles has been seen. Preoperative urodynamics are compared to results 3 years postoperatively. Conclusion: Bilateral S3 stimulation is a feasible and minimally invasive t reatment of urinary stress incontinence following implantation of an anteri or root stimulator.