[Neurosurgical treatment of hyperactive bladder in spinal cord injury patients].
OBJECTIVE
We report long-term results of posterior sacral root rhizotomies in combination with Finetech-Brindley anterior sacral root stimulators implanted intradurally in 20 spinal cord injury patients.


METHODS
and methods: The 14 female and 6 male patients included 14 paraplegics and 6 tetraplegics. All of them initially presented hyperactive bladder, detrusor-sphincter dyssynergia, recurrent urinary tract infection and performed (self) intermittent catheterization. Prior to implantation, an intrathecal test using bupivacaine was performed to confirm the compliances of the bladder. The main indication for implantation was persistent urinary incontinence refractory to medical therapy.


RESULTS
After implantation the mean follow-up was 4,5 years. In all, 18 patients used the stimulator alone for bladder emptying and 18 patients were completely continent. The mean bladder capacity increased from 190 ml preoperatively to 460 ml after the operation. The mean residual urinary volume was reduced from 90 ml to 25 ml. No changes were noted by renal isotopic scanning in upper urinary tracts of patients. In 1 patient, a second extradural implant was performed.


CONCLUSIONS
This article also include an overview of a) the different available sites where application of electrical stimulation results in a detrusor contraction, b) the benefits and disadvantages of the sacral posterior rhizotomy, c) selective stimulation techniques that allow selective detrusor activation by sacral root stimulation.


CONCLUSIONS
Sacral anterior root stimulation combined with sacral posterior rhizotomy is a valuable method to restore bladder functions in spinal cord injured patients suffering from hyperactive bladder refractory to medical therapy.
Services de Neurochirurgie A et B, Hôpital Gui-de-Chauliac, CHU, 80, avenue Augustin-Fliche, 34295 Montpellier Cedex 5. l-bauchet@chu-montpellier.fr
L
L
Bauchet
F
F
Segnarbieux
G
G
Martinazzo
P
P
Frerebeau
F
F
Ohanna
D000293:Adolescent; D000328:Adult; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D013126:Spinal Nerve Roots / Q000601:surgery; D001743:Urinary Bladder / Q000294:innervation; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000601:surgery* / Q000628:therapy; D014549:Urinary Incontinence / Q000209:etiology; D014554:Urination / Q000502:physiology; D014563:Urodynamics / Q000502:physiology