title: Successful bilateral pudendal neuromodulation to treat male detrusor areflexia following severe pubic symphysis fracture, a case report.
abstract: BACKGROUND
  A Drum Dock Manager in an auto manufacturing company suffers a pelvic fracture, severing the bulbar urethra and completely fracturing the right side of his pelvis. He is unable to void without catheterization but has a complete sensation to void. Can neuromodulation help him achieve spontaneous voiding?
  
  
  METHODS
  We reviewed the electronic medical record of Mr. M.E. from Detroit Medical Center following his 2012 forklift accident and subsequent orthopedic surgeries. He successfully underwent bilateral sacral neuromodulation, with a resulting max flow of 16.8 mls/sec and post-void residual urine of 50-100 mls. Unfortunately, he later presented with bilateral pocket and sacral lead infection, and both systems had to be removed. Six weeks later, M.E. had bilateral pudendal neurostimulation placement to avoid the previously infected areas. Max flow improved to 14.5 mls/sec and 0-50 mls residual urine. However, urodynamics proved that his Pdet at max flow was in excess of 120 cm of H20 pressure while he had been on finesteride and tamsulosin for the preceding five years for the management of his documented benign prostate hyperplasia symptoms. He underwent Green light laser transurethral resection of the prostate and had max flow improvement to 22.5 mls/second with zero residual urine with multiple straight catheterization confirmations.
  
  
  CONCLUSIONS
  Sacral neuromodulation may successfully correct traumatic urinary retention in male patients. Additionally, pudendal neuromodulation can be successfully utilized as a salvage method for an infected sacral neuromodulation impulse generator (IPG) and tined lead with a return to proper voiding.
authors.affiliation: Department of Urology, Detroit Medical Center, Harper Hospital, Detroit, MI, 48202, USA. urourogyn@yahoo.com.
authors.forename: Serge P
authors.initials: SP
authors.lastname: Marinkovic
authors.affiliation: Department of Urology, Detroit Medical Center, Harper Hospital, Detroit, MI, 48202, USA. bmiller@dmc.org.
authors.forename: Brandi
authors.initials: B
authors.lastname: Miller
authors.affiliation: Department of Urology, Detroit Medical Center, Harper Hospital, Detroit, MI, 48202, USA. shughes@dmc.org.
authors.forename: Scott
authors.initials: S
authors.lastname: Hughes
authors.affiliation: Department of Urology, Detroit Medical Center, Harper Hospital, Detroit, MI, 48202, USA. csmarinkovic@yahoo.com.
authors.forename: Christina
authors.initials: C
authors.lastname: Marinkovic
authors.affiliation: Department of Urology, Detroit Medical Center, Harper Hospital, Detroit, MI, 48202, USA. lgillen@decparks.com.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gillen
mesh_terms: D050723:Fractures, Bone / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011631:Pubic Symphysis / Q000293:injuries*; D060525:Pudendal Nerve; D062187:Spinal Cord Stimulation / Q000379:methods*; D016896:Treatment Outcome; D014521:Urethra / Q000293:injuries; D001750:Urinary Bladder, Neurogenic / Q000150:complications* / Q000628:therapy*