Neurosurgical treatment of hyperactive bladder in spinal cord injury patients

Objectives: We report long-term results of posterior sacral root rhizotomie s in combination with Finetech-Brindley anterior sacral root stimulators im planted intradurally in 20 spinal cord injury patients. Material and methods: The 14 female and 6 male patients included 14 paraple gics and 6 tetraplegics. All of them initially presented hyperactive bladde r, detrusor-sphincter dyssynergia, recurrent urinary tract infection and pe rformed (self) intermittent catheterization. Prior to implantation, an intr athecal test using bupivacaine was performed to confirm the compliances of the bladder. The main indication for implantation was persistent urinary in continence refractory to medical therapy. Results: After implantation the mean follow-up was 4,5 years. In all, 18 pa tients used the stimulator alone for bladder emptying and 18 patients were completely continent. The mean bladder capacity increased from 190 mi preop eratively to 460 mi after the operation. The mean residual urinary volume w as reduced from 90 mi to 25 mi. No changes were noted by renal isotopic sca nning in upper urinary tracts of patients. In 1 patient, a second extradura l implant was performed. Discussion: This article also include arl overview of a) the different avai lable sites where application of electrical stimulation results in a detrus or contraction, b) the benefits and disadvantages of the sacral posterior r hizotomy, c) selective stimulation techniques that allow selective detrusor activation by sacral root stimulation. Conclusion: Sacral anterior root stimulation combined with sacral posterior rhizotomy is a valuable method to restore bladder functions in spinal cord injured patients suffering from hyperactive bladder refractory to medical therapy.