Denervation techniques (Reprinted from BJU Int, vol 85, pg 1-6, 2000)

The bladder can be denervated at several levels: centrally, at the level of the sacral nerves: peripherally, on the pelvic nerves; or in the bladder, by cutting the relevant structures, by injecting substances toxic to nerves , or by hyperbaric bladder distension, These procedures target the sensory or motor nerves to weaken or to interrupt the detrusor reflex are. Most of the procedures introduced previously, e.g, bladder trans-section by open op eration, endoscopic or transvesical phenolization, hyperbaric bladder diste nsion, and peripheral denervation of the bladder, have now been abandoned, Although some of these techniques had a high initial success rate in abolis hing detrusor overactivity and in controlling incontinence, the relapse rat e within 18 months approached 100%, In the Early 1950s, much of the denerva tion surgery was performed on sacral roots and nerves. Nowadays, sacral de- afferentiation of the bladder by dorsal sacral root rhizotomy of S2-S5, usi ng specialized techniques, either intradurally or at the conal level, has p roved to be a very effective procedure for patients with spinal cord injuri es and detrusor hyper reflexia, functional low compliance and reflex incont inence, which cannot be managed by any other means, In conclusion, although in approximate to 90% of patients the symptoms of an overactive bladder wi ll be eliminated or improved by conservative methods of treatment, bladder denervation procedures still have a place in the management of these patien ts. In particular, with these procedures a low-pressure bladder system can be obtained and urinary continence restored in patients with complete supra sacral spinal cord lesions.