Study design: Cross-sectional study. Objective: To evaluate the long-term effect of the sacral anterior root stimulator (SARS) on neurogenic bowel dysfunction in a large, well defined spinal cord injury (SCI) cohort. Setting: Department of Neuro-Urology, Bad Wildungen, Germany. Methods: Subjects undergone surgery at for SARS-SDAF (sacral deafferentation) between September 1986 and July 2011 (n = 587) answered a questionnaire. In total, 277 SARS subjects were available for the baseline (recall) and follow-up comparison. Results: Median age was 49 years (range: 19-80), time from SCI to surgery was 10 years (range: 0-49) and from surgery to follow-up 13 (range: 1-25). Of the responders 73% used SARS for bowel emptying. On visual analog scale (VAS) ranging from 0-10 (best), satisfaction with SARS was 10. Baseline and follow-up comparison showed a decline in the median VAS score 0-10 (worst) for bowel symptoms from 6 (range: 4-8) to 4 (range: 2-6), Po0.0001; median neurogenic bowel dysfunction score from 17 (range: 11-2) to 11 (range: 9-15), Po0.0001; median St Marks score from 4 (range: 0-7) to 4 (range: 0-5), P = 0.01; and median Cleveland constipation score from 7 (range: 6-10) to 6 (range: 4-8), Po0.0001. Use of suppositories, digital evacuation and mini enema and subjects totally dependent on assistance during defecation were significantly lower after SARS. Conclusions: The SARS has the potential to be one of the few treatment methods targeting multiple organ dysfunctions following SCI.

This is the first study demonstrating the clinical usefulness of Botox therapy in clinical practice. Successful treatment resulted in lower costs for NDO associated morbidity due to less need for incontinence aids and UTI medication.

The discreet design of the compact catheter significantly improved patient quality of life related to intermittent self-catheterization.

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SDAF is able to restore the reservoir function of the urinary bladder and to achieve continence. Autonomic dysreflexia disappeared in most of the cases. By means of an accurate adjustment of stimulation parameters it is possible to accomplish low resistance micturition. The microsurgical technique requires an intensive education. One has to be able to manage late implant complications.