Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury.
BACKGROUND
The study aim was to investigate potential influences on human nerves and pelvic organs through early implantation of bilateral sacral nerve modulators (SNMs) in complete spinal cord injury (SCI) patients during the acute bladder-areflexia phase.


METHODS
Ten patients with neurologically-confirmed complete spinal cord lesions (SCLs) were provided with bilateral SNMs during the phase of atonic-detrusor muscle. Modulation was achieved by two electrodes implanted into each S(3)-foramen. Six patients declined and served as controls. The mean follow-up was 26.2 months.


RESULTS
Videourodynamics (VU) confirmed detrusor acontractility, resulting in urinary continence as well as significant reductions in urinary tract infections (UTIs). Bowel movements did not require oral laxatives; additional preprogrammed parameters achieved erections for intercourse.


CONCLUSIONS
Early SNM implantation in SCI patients may revolutionize neurogenic lower urinary tract (LUT) dysfunction management; it prevented detrusor overactivity and urinary incontinence, ensured normal bladder capacity, reduced UTI rates, and improved bowel and erectile functionality without nerve damage.


CONCLUSIONS
Future SCI investigations will be conducted to evaluate the potential benefits of even earlier SNM placement to progressively enhance pelvic organ functionality. This new approach may provide important clues required for assessing whether neuronal information is passed through the sympathetic trunk ganglion to the brain after complete SCI. Further investigations are needed to determine if functional magnetic resonance imaging (fMRI) might be helpful for analyzing changes in brain function in patients with SNMs and those taking antimuscarinics.
Sievert
Karl-Dietrich
KD
Department of Urology, University of Tuebingen, Tuebingen, Germany. Karl.Sievert@med.uni-tuebingen.de
Amend
Bastian
B
Gakis
G
G
Toomey
P
P
Badke
A
A
Kaps
H P
HP
Stenzl
Arnulf
A
D000328:Adult; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010525:Peripheral Nerves / Q000503:physiopathology*; D019736:Prostheses and Implants; D012447:Sacrum; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D014549:Urinary Incontinence / Q000503:physiopathology / Q000517:prevention & control*; D055815:Young Adult