title: Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury.
abstract: OBJECTIVE
  To investigate the outcome and complications of sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) in patients with neurogenic lower urinary tract dysfunction (NLUTD) resulting from complete spinal cord injury (SCI).
  
  
  METHODS
  Retrospective chart analysis of 137 patients who underwent SDAF/SARS at a single institution. Patients were categorized as being at risk of renal damage when the maximum detrusor pressure was >40 cmH2 O or detrusor compliance was <20 ml/cmH2 O.
  
  
  RESULTS
  After a mean follow-up time of 14.8 ± 5.3 years, SDAF/SARS treatment significantly (P < 0.001) reduced the number of patients suffering from elevated detrusor pressure from 65 to 2, and from low detrusor compliance from 62 to 13, respectively. Mean bladder capacity significantly (P < 0.001) improved from 272.4 ± 143.0 to 475.0 ± 82.7 ml. The mean number of symptomatic UTI also decreased significantly (P < 0.001) from 6.2 ± 4.5 to 2.5 ± 2.6 per year. The number of patients suffering from incontinence had significantly (P < 0.001) decreased from 70 to 44. At the last follow-up visit, 107 (78.1%) patients were still using the stimulator. A total of 84 complications requiring surgical revision were observed. Defects of the stimulator cables or the receiver plate were the most common events (n = 38). The retrospective design pertains to the limitations of the study.
  
  
  CONCLUSIONS
  Sacral deafferentation and SARS are an effective treatment option for refractory NLUTD in patients with complete SCI, despite a substantial long-term complication rate.
authors.affiliation: Department of Neurourology, Marienhospital Herne, Herne, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Krasmik
authors.forename: Jörg
authors.initials: J
authors.lastname: Krebs
authors.forename: Arndt
authors.initials: A
authors.lastname: van Ophoven
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
mesh_terms: D000328:Adult; D000344:Afferent Pathways; D004599:Electric Stimulation Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008297:Male; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D013126:Spinal Nerve Roots; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D014563:Urodynamics
keywords: Brindley stimulator; neurogenic bladder dysfunction; sacral deafferentation and anterior root stimulation; spinal cord injury; urodynamics