Bilateral chronic sacral neuromodulation for treatment of lower urinary tract dysfunction.
OBJECTIVE
Chronic sacral neuromodulation aims at functional restoration of selected forms of nonneurogenic and neurogenic bladder dysfunction. The original technique, as described by Tanagho and Schmidt, provides unilateral sacral nerve stimulation via an implanted stimulator powering an electrode inserted into a sacral foramen. Its drawback was that the implant failed unpredictably in some patients despite previous successful percutaneous test stimulation. Therefore, we modified the stimulation technique to improve the efficacy of chronic sacral neuromodulation.


METHODS
Guarded bipolar electrodes powered by an implantable neurostimulator were attached bilaterally directly to the S3 nerves through a sacral laminectomy in 9 women and 2 men (mean age 43.4 years). Of the patients 5 had urinary incontinence due to detrusor hyperactivity and 6 had urinary retention from detrusor hypocontractility. Mean followup with repeated urodynamics was 13 months (range 9 to 28).


RESULTS
Four significant complications were encountered in 4 patients. In 10 patients the urological sequelae of the neurological disorder were alleviated significantly (50% or more), including 5 who experienced complete relief of symptoms.


CONCLUSIONS
The efficacy of chronic sacral neuromodulation can be improved by bilateral attachment of electrodes directly to the sacral nerves.
Department of Urology, University of Mainz, Germany.
M
M
Hohenfellner
D
D
Schultz-Lampel
S
S
Dahms
K
K
Matzel
J W
JW
Thüroff
D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000502:physiology; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000628:therapy*
D018377:Neurotransmitter Agents