Sacral neuromodulation as a therapeutic alternative in vesico-sphincter dyssynergias in patients with spinal cord injuries
DOI:
https://doi.org/10.47924/neurotarget2007364Keywords:
supraconal spinal lesion, urethral-bladder dyssynergia, sacral neuromodulationAbstract
The purpose of this study is to evaluate Chronic Sacral Neuromodulation as an alternative treatment modality for patients that have a spinal lesion above the conal area of the spinal cord and whose symptoms are manifested as Urgency-Frequency Syndrome or Urge Urinary Incontinence.
The study included 8 patients with chronic spinal lesion of traumatic etiology above the cone (S2-S4). The patients were treated with neuro stimulation of the sacral plexus using a tetra polar lead placed thru the S3 foramen, a line of connection, and a pulse generator InterStim® model (Medtronic, Minneapolis, MN) placed in the paraumbilical abdominal subcutaneous tissue. The study was carried out since 1996 to 2006 with a post operative follow up period that lasted 36 months in average (2 to 6 years). A generator was implanted through the S3 foramen after a satisfactory transitory stimulation test (50% symptoms improvement), a therapeutic test previous to the definitive implant, that involved the placement of a tetra polar lead into the spinal canal percutaneously thru the same S3 foramen; the lead was connected to an external pulse generator which remained “on” 24 hours a day during 7 to 21 days; the requirement to consider the test as “satisfactory”, was an improvement equal or greater than 50%.
The electro stimulation during 36 months reestablished the balance and coordination of the spinal-bladder reflex in all the patients. The greater manifestation of basal symptoms improvement was achieved after 6 months and maintained during the following months.
We observed a significant decrease of 86% (80% to 90%) in the number of incontinence episodes, accompanied by a decrease of 80% (70% to 85%) in the volume of leaking, confirmed by pad testing, with a parallel and correlative increase of spontaneous urination volume every 24 hours, according to the data reported in the patient’s urination records.
This technique has generated an important benefit for patients suffering from refractory neurogenic bladder, secondary to partial or total lesion of the supraconal spinal cord, and for those for whom the pharmacological treatment had failed; in addition, it implied a small risk and absolute reversibility.
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References
Juenemann KP, Lue TF, Schmidt RA, Tanagho EA. Clinical significance of sacral and pudendal nerve anatomy. J Urol. 1988;139(1):74-80.
Nashold BS, Goldner JL, Mullen JB, Bright DS. Long-term pain control by direct peripheral-nerve stimulation. J Bone Joint Surg Am. 1982;64(1):1-10
Agnew WF, McCreery DB, Yuen TG, Bullara LA. Histologic and physiologic evaluation of electrically stimulated peripheral nerve: considerations for the selection of parameters. Ann Biomed Eng. 1989;17(1):39-60.
Schmidt RA, Bruschini H, Tanagho EA. Urinary bladder and sphincter responses to stimulation of dorsal and ventral sacral roots. Invest Urol. 1979;16(4):300-4.
De Araujo CG, Schmidt RA, Tanagho EA. Neural pathways to lower urinary tract identified by retrograde axonal transport of horseradish peroxidase. Urology. 1982;19(3):290-5.
Thüroff JW, Bazeed MA, Schmidt RA, Luu DH, Tanagho EA. Regional topography of spinal cord neurons innervating pelvic floor muscles and bladder neck in the dog: a study by combined horseradish peroxidase histochemistry and autoradiography. Urol Int. 1982;37(2):110-20.
Thüroff JW, Schmidt RA, Bazeed MA, Tanagho EA. Chronic stimulation of the sacral roots in dogs. Eur Urol. 1983;9(2):102-8.
Yuen TG, Agnew WF, Bullara LA. Histopathological evaluation of dog sacral nerve after chronic electrical stimulation for micturition. Neurosurgery. 1984;14(4):449-55.
Hassouna MM. Neuromodulation and growth factors in the lower urinary tract. In: Jonas U, Grünewald V, editors. New perspectives in Sacral Nerve Stimulation for Control of Lower Urinary Tract Dysfunction. London: Martin Dunitz; 2002. p. 55-68.
Shaker H, Wang Y, Loung D, Balbaa L, Fehlings MG, Hassouna MM. Role of C-afferent fibres in the mechanism of action of sacral nerve root neuromodulation in chronic spinal cord injury. BJU Int. 2000 May;85(7):905-10.
Jonas U, Heine JP, Tanagho EA. Studies on the feasibility of urinary bladder evacuation by direct spinal cord stimulation. I. Parameters of most effective stimulation. Invest Urol. 1975;13(2):142-50.
Schmidt RA, Bruschini H, Van Gool J, Tanagho EA. Micturition and the male genitourinary response to sacral root stimulation. Invest Urol. 1979;17(2):125-9.
Schmidt RA, Tanagho EA. Feasibility of controlled micturition through electric stimulation. Urol Int. 1979;34(3):199-230.
Schmidt RA. Neural prostheses and bladder control. Eng Med Biol. 1983;2:31-6.
Schmidt RA. Advances in genitourinary neurostimulation. Neurosurgery. 1986;19(6):1041-4.
Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol. 1988;140(6):1331-9.
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Copyright (c) 2007 Miguel Ángel Zangone
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