Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury

Sievert, Karl‐Dietrich; Amend, Bastian; Gakis, Georgios; Toomey, Patricia; Badke, Andreas; Kaps, Hans-Peter; Stenzl, Arnulf

doi:10.1002/ana.21814

Cited by 178 publications

(129 citation statements)

References 42 publications

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“…But the results of the recent literature showed that early SNM can prevent urinary incontinence after complete spinal cord injury. 20 They indicated acute SCI initially leads to detrusor acontractility and complete urinary retention, which is followed by slow overactivity development and urinary incontinence caused by C-fiber-mediated spinal reflex pathways, probably related to the interrupted regulatory mechanism between the end organ (bladder and urethral sphincter and midbrain for the two separated pathways of micturition and continence). Early SNM bilateral implantation during the bladder-areflexia phase might preserve nerve plasticity, such that C-fibers remain silent, DO is avoided, and sympathetic preganglionic neuron activation in the thoracolumbar cord is suppressed.…”

Section: Discussionmentioning

confidence: 99%

Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease

Chen

Liu

2014

Spinal Cord

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Study design: Retrospective case series. Objectives: The primary aim was to assess the clinical effects of sacral neuromodulation (SNM) for neurogenic bladder and/or bowel dysfunction with multiple symptoms secondary to spinal cord disease or injury. Setting: Beijing, China. Methods: Between 2011 and 2013, 23 patients with multiple bladder and/or bowel problems secondary to spinal cord disease or injury were treated with a preliminary test SNM. If at least 50% clinical improvement occurred, then the patient underwent a permanent SNM procedure. We evaluated the patients using a bladder diary, post-void residual volume measurement and the Wexner questionnaire score for constipation before the test phase, during the test phase and after the permanent SNM. Results: In the test phase, the rate of improvement in dysuria (29.4%) was significantly lower than urgency frequency (64.7%), urinary incontinence (69.2%) and constipation (75.0%). An implant was performed in 13 (56.5%) patients, including 4 patients who still used intermittent catheterization to exclude urine after permanent SNM because the symptom of dysuria could not be improved significantly and 1 patient who achieved X50% improvement in lower urinary tract dysfunction but not in constipation. During follow-up (17.5 ± 2.0 months), 1 patient (7.7%) failed and 1 patient had bilateral vesicoureteral reflux. Conclusion: Chronic SNM cannot always resolve all the bladder and bowel symptoms secondary to spinal cord disease or injury, but combined with other treatments may help improve multiple symptoms.

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Section: Discussionmentioning

confidence: 99%

Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease

Chen

Liu

2014

Spinal Cord

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“…This leads to improvement in urodynamic parameters and increased reservoir capacity of the urinary bladder while maintaining low intrabladder pressure. 40,41 The evidence for the role of botulinum toxin in the prevention of urinary tract infection in patients with spinal cord injury comes from small observational studies. In one study, the mean number of urinary tract infections over six months was 1.75 ± 1.87 in 30 patients with spinal cord injury and detrusor hyperactivity.…”

Section: Effective Bladder Drainage and Low Detrusor Pressurementioning

confidence: 99%

“…The exact mechanism of action for sacral neuromodulation is poorly understood and requires more research. 41 Sacral neuromodulation can help to achieve normal bladder capacity, avoid incontinence and increase self-catheterization time intervals, which in turn helps to avoid urinary tract infections. It is also anticipated to improve bowel and erectile functions.…”

Section: Sacral Neuromodulationmentioning

confidence: 99%

Prevention of urinary tract infections in patients with spinal cord injury

Salameh

Mohajer

Daroucihe

2015

CMAJ

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“…Remarkably, early bilateral SNM during the phase of spinal shock phase could prevent NDO and subsequent urinary incontinence in complete SCI patients [60]. However, long-term results are pending and the exact mechanism of action is not well understood [61].…”

Section: Permanent Neuromodulation With Implanted Electrodesmentioning

confidence: 99%

The management of urinary incontinence in the male neurological patient

Mehnert

Kessler

2014

Current Opinion in Urology

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PURPOSE OF REVIEW: Urinary incontinence in male neurological patients is a very frequent problem but treatment remains challenging. Thus, we summarize and highlight the latest developments in the management of urinary incontinence in this specific patient population. RECENT FINDINGS: Intermittent self-catheterization, antimuscarinics, intradetrusor injections with onabotulinumtoxinA, augmentation cystoplasty, urinary diversion, and artificial urinary sphincter are the cornerstones of the armamentarium for treating neurogenic urinary incontinence. However, with the exception of onabotulinumtoxinA intradetrusor injections, level of evidence is often low and male-specific outcomes are virtually not available. Alternative conservative and/or minimally invasive procedures such as neuromodulation techniques and suburethral suspension devices provide promising data with apparently good safety and tolerability but still insufficient evidence lacking randomized control trials. SUMMARY: Standard options for treatment of urinary incontinence in neurological patients remain largely unchanged. Alternative treatment options, especially of conservative or minimally invasive character, have the potential to further broaden the therapeutic spectrum. While a higher level of evidence is needed to assess the potential of such therapeutic approaches, randomized controlled trials in the male neurological population present a challenge. To truly advance treatment of urinary continence in male neurological patients, well-designed, multicenter studies are warranted. Purpose of review Urinary incontinence in male neurological patients is a very frequent problem but treatment remains challenging. Thus, we summarize and highlight the latest developments in the management of urinary incontinence in this specific patient population. Recent findingsIntermittent self-catheterization, antimuscarinics, intradetrusor injections with onabotulinumtoxinA, augmentation cystoplasty, urinary diversion, and artificial urinary sphincter are the cornerstones of the armamentarium for treating neurogenic urinary incontinence. However, with the exception of onabotulinumtoxinA intradetrusor injections, level of evidence is often low and male-specific outcomes are virtually not available. Alternative conservative and/or minimally invasive procedures such as neuromodulation techniques and suburethral suspension devices provide promising data with apparently good safety and tolerability but still insufficient evidence lacking randomized control trials. SummaryStandard options for treatment of urinary incontinence in neurological patients remain largely unchanged. Alternative treatment options, especially of conservative or minimally invasive character, have the potential to further broaden the therapeutic spectrum. While a higher level of evidence is needed to assess the potential of such therapeutic approaches, randomized controlled trials in the male neurological population present a challenge. To truly advance treatment of urinary continence in mal...

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Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury

Cited by 178 publications

References 42 publications

Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease

Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease

Prevention of urinary tract infections in patients with spinal cord injury

The management of urinary incontinence in the male neurological patient

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