[Sacral deafferentation and neurostimulation of anterior spinal roots in the treatment of neurogenic bladder in patients with complete transverse spinal lesions--initial clinical experience].
Of those patients who survived the first years after traumatic severing of the spinal cord 85% die from urological complications, their life span being significantly reduced unless they are adequately treated. Sacral deafferentation and electrostimulation of the urinary bladder is in recent years one of the most effective therapeutic methods of neuropathic urinary bladder caused by suprasacral transverse spinal lesions: rhizotomy permanently increases the compliance of the bladder, eliminates hyperreflexion of the detrusor and detrusor-sphincteric dyssynergy--the main causes of nephropathy and urinary incontinence; implantation of a stimulator of the anterior spinal roots enables the patient to control micturition, possibly also defaecation and erection. In countries of the former eastern European bloc the method was not used so far. From January to September 2001 in the Faculty Hospital Brno six patients were operated with complete suprasacral spinal lesions caused by injuries of the spine (from C4 to Th9). All patients recovered without complications. In five patients complete continence was restored, in all six hyperreflexia of the detrusor disappeared completely, four patients use from the second week a neurostimulator for micturition whereby the micturition pressure does not exceed physiological values and the post-micturition residue is negligible. One of the two patients where the response of the bladder to stimulation disappeared during the first week started to use the stimulator again during the 7th month after surgery. Another patient waits now for 5 months for complete regeneration of motor pathways and urinates using intermittent catheterization. Four patients use from the very beginning a neurostimulator for defaecation and one for assisted defaecation. Four patients evaluate the result of surgery as excellent, one as good and he expects further improvement from the effect of stimulation, he objects to the stress incontinence of urine. One patient appreciates the restored urinary continence, but awaits the restored effect of stimulation and therefore is not yet satisfied with the operation.
Dolezel
J
J
Neurochirurgická klinika LF MU a FN, Brno.
Cejpek
P
P
Miklánek
D
D
D000328:Adult; D004599:Electric Stimulation Therapy / Q000295:instrumentation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019051:Rhizotomy; D013119:Spinal Cord Injuries / Q000150:complications*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000601:surgery*