Sacral root stimulation for controlled micturition: prevention of detrusor-external sphincter dyssynergia by intraoperative identification and selective section of sacral nerve branches.
Electrical stimulation of the S2 nerve root can be used to produce detrusor contraction and voiding in patients with spinal cord injury, but concurrent stimulation of the external urethral sphincter causes detrusor-sphincter dyssynergia. This has been managed with a second surgical procedure, peripheral transection of the pudendal nerve. In this study, performed in dogs after spinal cord transection, laminectomy and ventral foraminotomy permitted tracing of the S2 root into the pelvis, where its branches were identified by electrical stimulation and urodynamic recording. The pudendal (somatic) branch was sectioned; the autonomic branch innervating the detrusor was preserved. Electrical stimulation of the proximal S2 root then produced detrusor contraction without contraction of the external urethral sphincter. This approach, which requires a single operation and spares pudendal nerve functions mediated by nerve roots other than S2, may enable a neurostimulator to provide effective voiding, without detrusor-external sphincter dyssynergia, in man.
Montefiore Medical Center, Henry and Lucy Moses Hospital Division, Department of Urology, Springfield, Ohio.
A S
AS
Haleem
F
F
Boehm
A D
AD
Legatt
A
A
Kantrowitz
B
B
Stone
A
A
Melman
D000818:Animals; D004285:Dogs; D004599:Electric Stimulation Therapy; D007430:Intraoperative Care / Q000379:methods; D007796:Laminectomy; D013119:Spinal Cord Injuries / Q000150:complications; D013126:Spinal Nerve Roots / Q000502:physiology*; D014521:Urethra / Q000294:innervation; D001743:Urinary Bladder / Q000294:innervation*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000517:prevention & control*; D016741:Urinary Sphincter, Artificial; D014554:Urination / Q000502:physiology*; D014563:Urodynamics / Q000502:physiology