[Continuous bilateral sacral neuromodulation as a minimally invasive implantation technique in patients with functional bladder changes].
OBJECTIVE
Up to 50% of patients with bladder dysfunctions undergoing sacral neuromodulation treatment are non-responders. The most common treatment method today is the implantable neuromodulation system described by Tanagho and Schmidt; which allows unilateral sacral nerve stimulation. Our aim was to increase the number of responders and to improve the general efficiency of chronic sacral neuromodulation; therefore we have developed the bilateral electrode implantation by minimally invasive laminectomy.


METHODS
PNE-tests were carried out to assess which patients were likely to be good responders. Thirty patients (16 with detrusor instability, 14 with hypocontractile detrusors) were subjected to minimally invasive laminectomy and received implants of bilateral electrodes.


RESULTS
In those patients with a hyopcontractile detrusor, the level of residual urine of initially 350 ml was reduced to 58 ml, and the maximum detrusor pressure during micturition increased from initially 12 cMH2O to 34 cmH2O. In the other patient group with detrusor instability, the average number of incontinence incidences could be reduced from initially 7.2 to 1 per day, while the bladder capacity rose from 198 ml to 348 ml. The modulation effect did not show any signs of deteriorating in any of the patients. The follow-up period was 28 months on average.


CONCLUSIONS
Clinical experience has shown that optimal neuromodulation in patients with bladder dysfunction can be achieved by this new approach involving bilateral electrode implantation. Moreover, the laminectomy implantation method guarantees a minimum of invasive trauma and enables optimal placement and fixation of the electrode.
Martín Braun
Peter
P
Departamento de Urología, Hospital Universitario de Kiel, Universidad de Kiel, Alemania.
Arancibia Fernández
Mario Ignacio
MI
Martínez Portillo
Francisco J
FJ
Seif
Christoph
C
Sotelino Crespo
Antonio
A
Sugimoto
Shuji
S
de Dios Montoto
Emilia
E
Alken
Peter
P
Jünemann
Klaus-Peter
KP
D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008160:Lumbosacral Plexus / Q000503:physiopathology; D019060:Minimally Invasive Surgical Procedures; D009122:Muscle Hypertonia / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000628:therapy*