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Anterior sacral root stimulator (Brindley): Experiences especially in women with neurogenic urinary incontinence

1988; Wiley; Volume: 7; Issue: 6 Linguagem: Inglês

10.1002/nau.1930070608

1520-6777

H. Madersbacher, Julie R. Fischer, Arno Ebner,

Anorectal Disease Treatments and Outcomes

Abstract Six women and one man with complete (or almost complete) suprasacral lesions and with unbalanced reflex bladder and otherwise uncontrollable reflex incontinence received a radiolinked anterior sacral root stimulator using the intradural approach. At the same time the relevant posterior sacral roots were cut to abolish spontaneous reflex detrusor contractions. All patients were able to empty the bladder with physiologic detrusor pressure, with no or minimal residual urine, and they achieved urinary continence. Pre‐ and postoperative urodynamic findings are given as well as the intra‐operative details. The aims of this procedure, balanced voiding and urinary continence, were achieved in all seven patients; follow‐up in this series ranged from 6 months to 2 years. Our findings confirm the excellent results reported by Brindley and others with 155 implantations of an anterior sacral root stimulator worldwide. In our series so far no technical problems — either with the implant or with the external stimulation unit — have occurred; exact setting of the electric stimulation parameters provides physiologic detrusor pressures, and although micturition is achieved by poststimulus voiding, no increase of trabeculation could be observed. Achievement of urinary continence depends on the effect of the rhizotomy of the relevant sacral posterior roots performed at the same time intradurally. Further observation time will be necessary to prove its effectiveness in the long run. Even with these arguments in mind the results so far justify the implantation of an anterior sacral root stimulator together with a posterior root rhizotomy, especially in female patients with unbalanced reflex bladder together with reflex urinary incontinence which cannot be managed otherwise.