title: Urinary continence in spinal injury patients following complete sacral posterior rhizotomy.
abstract: Complete sacral posterior rhizotomy was carried out in 15 spinal injury patients in conjunction with implantation of sacral anterior root stimulators. All patients were incontinent pre-operatively and had video-pressure cystometry before and at regular intervals after surgery. Detrusor hyper-reflexia was totally abolished in all but 1 patient following rhizotomy and 87% no longer require any form of incontinence appliance. Deafferentation produced adverse changes in vesicourethral function and even when rhizotomy was complete, continence could not be guaranteed. The pre-operative state of the bladder neck and distal sphincter mechanism had an important bearing on future continence and those patients with a closed bladder neck and no previous sphincterotomy had the greatest chance of becoming continent after deafferentation. The majority of patients in this series are now fully continent, representing a transformation in their quality of life; it is recommended, however, that to optimise the success of rhizotomy precise pre-operative evaluation and selection of patients are essential.
authors: Spinal Injury Unit, Lodge Moor Hospital, Sheffield.
authors: R P
authors: RP
authors: MacDonagh
authors: D M
authors: DM
authors: Forster
authors: D G
authors: DG
authors: Thomas
mesh_terms: D000328:Adult; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013124:Spinal Injuries / Q000150:complications*; D013126:Spinal Nerve Roots / Q000601:surgery*; D001743:Urinary Bladder / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics