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

Abstract

and the Rehabilitation Centre Bad Haring of the Austrian Workers Compensation Board (H.M., J.F., A.E.) Bad Haring, AustriaSix 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. R e -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.

Sacral Rhizotomies and Electrical Bladder Stimulation in Spinal Cord Injury

“…In our series all female patients are continent even with bladder vol umes above 500 ml. Similar excellent results in women have been reported in an other series [22], In patients with a cervical lesion and a poor hand function, help from another person may be needed to activate the bladder controller. Therefore the daily life environment of each patient considered for this procedure must be taken into account.…”

“…A sacral anterior root stimulator, the FinetechBrindley bladder controller, has been available since 1984 but only recently the combined treatment of complete sacral posterior root rhizotomies together with implanta tion of this stimulator has gained general interest. A lim ited number of publications on the results of the com bined technique are available [21,22], A consistent prob lem with these investigations is a poor urodynamic evalu ation and the lack of well controlled follow-up data.…”

Results of the Treatment of Neurogenic Bladder Dysfunction in Spinal Cord Injury by Sacral Posterior Root Rhizotomy and Anterior Sacral Root Stimulation

“…Similar excellent results in wom en have been reported in another series. 26 In patients w ith a cervical lesion and poor hand function assistance from an o th er person may be needed to activate the bladder con troller. Therefore, the daily life environment of each candi d a te m ust be considered.…”

Neuromuscular electrical stimulation in neurorehabilitation

“…288,289 The use of the implant is associated with significant reduction in the incidence of symptomatic urinary tract infections. 42,68,193,289 Continence is achieved in over 85% of patients, 92,290 although 10%-15% report some stress incontinence of urine following the procedure. 191 Several centers in Europe have long-term follow-up experience with the device, particularly with regard to the upper tracts.…”