Adjuvant drug therapy: a review of 30 cases of sacral anterior root stimulator.
Implantation of a sacral anterior root stimulator in spinal cord injured patients must achieve two main goals to maintain a vesicosphincteral balance: complete bladder voiding and correct continence. During the postoperative period, difficulties may arise or persist with either an incontinence due to an insufficient deafferentation with bladder hyperreflexia or an incomplete voiding because of an insufficient contraction of detrusor and/or too high urethral resistances (vesicosphincteral dyssynergia). A third of our patients required specific therapies after implantation to promote interstimulation continence and complete bladder voiding. Regarding continence, adjuvant therapies are effective for bladder hyperreflexia in connection with a too-partial deafferentation. On the other hand, these therapies have little effect on low bladder compliance. In regard to bladder voiding, nonsurgical treatments are equally effective. These treatments (parasphincteral infiltrations, alpha-blockers) must not be permanent, but allow a reharmonizing between expulsive strengths and urethral resistances. Eighty percent of our patients who required adjuvant therapies have been improved significantly. This confirms the efficiency of adjuvant therapy and speaks for patience.
Isambert
J L
JL
Centre Hospitalier Specialise De L'Arche, Saint Saturnin, La Milesse, Le Mans, France.
Egon
G
G
Colombel
P
P
D017024:Chemotherapy, Adjuvant; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D013948:Moxisylyte / Q000627:therapeutic use*; D009119:Muscle Contraction; D009130:Muscle, Smooth / Q000503:physiopathology; D010264:Paraplegia; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000628:therapy*; D013126:Spinal Nerve Roots / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*
D013948:Moxisylyte