Sacral bladder denervation for treatment of detrusor hyperreflexia and autonomic dysreflexia

Objectives. Detrusor hyperreflexia after spinal cord injury may cause urina ry incontinence and chronic renal failure. In patients refractory to conser vative treatment and not eligible for ventral sacral root stimulation for e lectrically induced micturition, we investigated the therapeutic value of s acral bladder denervation as a stand-alone procedure. Methods. Nine patients (8 men and 1 woman) between 21 and 58 years old (mea n 30.2) with traumatic suprasacral spinal cord lesions underwent sacral bla dder denervation for treatment of detrusor hyperreflexia and/or autonomic d ysreflexia. Results. Detrusor hyperreflexia and autonomic dysreflexia were eliminated i n all cases. Bladder capacity increased from 177.8 +/- 39.6 to 668.9 +/- 64 .3 mL; intravesical pressure decreased from 89.3 +/- 19.1 to 20.2 +/-2.7 cm H2O. For facilitating clean intermittent catheterization (CIC), 4 patients received a continent vesicostomy in a second-stage procedure; one of them in combination with bladder augmentation. Four patients empty their bladder by way of urethral CIC. One completely tetraplegic patient has an indwelli ng urethral catheter. In the 5 patients with autonomic dysreflexia, the sys tolic blood pressure was lowered from 196 +/- 16.9 to 124 +/-9.3 mm Hg and the diastolic blood pressure from 114 +/-5.1 to 76 +/-5.1. The annual frequ ency of urinary tract infections decreased from 9 +/-1.2 to 1.8 +/-0.7. In all patients, renal function remained stable. Conclusions. In selected patients with detrusor hyperreflexia and/or autono mic dysreflexia, sacral bladder denervation is a valuable treatment option. It is only moderately invasive in nature, requires neither sophisticated n or expensive medical equipment, and is an attractive alternative to urinary diversion using intestinal segments. UROLOGY 58: 28-32, 2001. (C) 2001, El sevier Science Inc.