title: Long-term course of sacral anterior root stimulation in spinal cord injured individuals: The fate of the detrusor.
abstract: OBJECTIVE
  To investigate the long-term course of the detrusor pressure during sacral anterior root stimulation in spinal cord injury (SCI) patients.
  
  
  METHODS
  Retrospective evaluation of 111 patients who had undergone sacral deafferentation and implantation of an anterior root stimulator at a single SCI rehabilitation center with a minimum follow-up time of 5 years.
  
  
  RESULTS
  The median follow-up time was 11.7 years (range 5.0-24.9 years). The maximum detrusor pressure (Pdet_max) during stimulation was higher in men compared to women (P = 0.0004) and decreased over time (P = 0.0006). However, there were no significant (P ≥ 0.06) differences in the median Pdet_max during stimulation between the first measurement time point and any follow-up time point. The Pdet_max during stimulation decreased from 62 cmH2O (95%CI 57-73 cmH2O) to 53 cmH2O (95%CI 47-69 cmH2O) (P = 0.9). The time had also a significant effect on Pdet_max during the storage phase (P < 0.0001) and bladder compliance (P = 0.0007). The Pdet_max during the storage phase decreased, whereas bladder compliance increased during the follow-up period. There were no significant (P ≥ 0.1) changes over time in bladder capacity, the number of daily stimulations and the residual urine volume after voiding.
  
  
  CONCLUSIONS
  The detrusor pressure during sacral anterior root stimulation decreases over time in SCI individuals. However, the changes do not seem to be clinically relevant during the first decade after surgery.
authors: Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors: Jörg
authors: J
authors: Krebs
authors: Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors: Jens
authors: J
authors: Wöllner
authors: Spinal Surgery Orthopaedics, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors: Dennis
authors: D
authors: Grasmücke
authors: Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland.
authors: Jürgen
authors: J
authors: Pannek
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000503:physiopathology*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D062187:Spinal Cord Stimulation; D013126:Spinal Nerve Roots / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014554:Urination / Q000502:physiology*; D014563:Urodynamics / Q000502:physiology
keywords: detrusor pressure; neurogenic lower urinary tract dysfunction; sacral anterior root stimulation; sacral deafferentation; spinal cord injury; urodynamics