Long‐term course of sacral anterior root stimulation in spinal cord injured individuals: The fate of the detrusor

Krebs, Jörg; Wöllner, Jens; Grasmücke, Dennis; Pannek, Jürgen

doi:10.1002/nau.23161

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…For instance, pressure flow studies in subjects without any known urological pathology have also indicated a lower detrusor contractility in women compared to men and a higher peak detrusor pressure and higher detrusor pressure during maximum flow rate in men compared to women 25,31,32 . A higher maximum detrusor pressure was also maintained in men compared to women with a spinal cord injury and undergoing sacral anterior root stimulation to facilitate voiding 33 . Animal studies also provide support to the notion of sexual dimorphism of detrusor function, as a higher maximum flow rate and longer micturition time were shown in male compared to female rats undergoing cystometry 34 .…”

Section: Discussionmentioning

confidence: 91%

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Sexual dimorphism of detrusor function demonstrated by urodynamic studies in rhesus macaques

Biscola

Christe

Rosenzweig

et al. 2020

Sci Rep

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The lower urinary tract (LUT) and micturition reflexes are sexually dimorphic across mammals. Sex as a biological variable is also of critical importance for the development and translation of new medical treatments and therapeutics interventions affecting pelvic organs, including the LUT. However, studies of LUT function with comparisons between the sexes have remained sparse, especially for larger mammals. Detrusor function was investigated by filling cystometry and pressure flow studies in 16 male and 22 female rhesus macaques. By filling cystometry, male subjects exhibited a significantly larger bladder capacity and compliance compared to females. Pressure flow studies showed a significantly higher bladder pressure at voiding onset, peak pressure, and elevation in detrusor-activated bladder pressure from the end of bladder filling to peak pressure in the male subjects. The activation of reflex micturition, with associated detrusor contractions, resulted in voiding in a significantly larger proportion of female compared to male subjects. A higher urethral outlet resistance is suggested in the male subjects. We conclude that sexual dimorphism of detrusor function is prominent in rhesus macaques, shares many features with the human, and merits consideration in translational and pre-clinical research studies of micturition and LUT function in non-human primates.

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Section: Discussionmentioning

confidence: 91%

“…Differences between males and females with regards to detrusor contractility and bladder pressures during micturition have been attributed to a greater outflow resistance in males 27,33,36 . The striated EUS muscle is well developed in male but not female rats 35 .…”

Section: Discussionmentioning

confidence: 99%

Sexual dimorphism of detrusor function demonstrated by urodynamic studies in rhesus macaques

Biscola

Christe

Rosenzweig

et al. 2020

Sci Rep

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“…At the end of the selection process, 38 articles were retained for analysis including 24 retrospective studies (5-28), 4 prospective studies (29-32), 4 cross-sectional studies (33-36), 4 case reports (37-40), 1 survey (41) and 1 basic research article (42). Among these publications, 6 dealt with individuals quality of life (29,30,33-36), and 8 others including two case reportswere placed in the category "Other considerations" (5,6,(37)(38)(39)(40)(41)(42). The axes "Benefits for visceral functions" and "Implantation procedure and reliability" regrouped the 24 remaining publications.…”

Section: Research Process and Study Designmentioning

confidence: 99%

“…Eight publications were retained to complement this review as they were dealing with aspects little or not documented in previous studies (Table 5; 204 individuals from level IV or V studies including 4 case studies). Among these papers, six dealt directly with the consequences of implantation (5,6,(37)(38)(39)(40), while the last two (41,42) were focused on the prospects of this design of implant. (41) attempted to identify patients' preferences for future neuroprostheses and highlighted the major role of the benefit-risk ratio on implant acceptability.…”

Section: Additional Informationmentioning

confidence: 99%

Sacral Anterior Root Stimulation and Visceral Function Outcomes in Spinal Cord Injury–A Systematic Review of the Literature Over Four Decades

et al. 2022

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Study design: Systematic ReviewObjectives: The sacral anterior root stimulator (SARS) was developed 40 years ago to restore urinary and bowel functions to individuals with spinal cord injury (SCI). Mostly used to restore lower urinary tract function, SARS implantation is coupled with sacral deafferentation to counteract the problems of chronic detrusor sphincter dyssynergia and detrusor overactivity. In this article, we systematically review 40 years of SARS implantation and assess the medical added-value of this approach in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses). We identified four axes of investigation: i) impact on visceral functions, ii) implantation safety and device reliability, iii) individuals quality of life, and iv) additional information about the procedure.Methods: Three databases were consulted: Pubmed, EBSCOhost and Pascal. 219 abstracts were screened and 38 publications were retained for analysis (1,147 implantations). Results:The SARS technique showed good clinical results (85.9% of individuals used their implant for micturition and 67.9% to ease bowel movements) and improved individual quality of life. Conversely, several sources of complications were reported after implantation (surgical complications, failures etc.).Conclusions: Despite promising results, a decline in implantations was observed. This decline can be linked to the complication rate, as well as to the development of new therapeutics (botulinum toxin, etc.) and directions for research (spinal cord stimulation) that may have an impact on people. Nevertheless, the lack of alternatives in the short-term suggests that the SARS implant is still relevant for the restoration of visceral functions after SCI.

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“…For example, sacral nerve stimulation (SNS) [4] therapy and transcutaneous tibial nerve stimulation (TTNS) [5–7] therapy have been used to treat subjects with SCI and NDO. Although both TTNS and SNS therapies have been reported to significantly improve urinary continence by increasing bladder capacity in subjects with incomplete SCI [5–7], a few recent studies report that TTNS and SNS did not produce a satisfactory outcome in related clinic trials [8, 9]. Moreover, these two neuromodulation approaches are not effective for increasing bladder capacity in individuals with complete SCI; it is still unclear why both approaches failed to improve urinary continence in these individuals.…”

Section: Introductionmentioning

confidence: 99%

Effects of Genital Nerve Stimulation Amplitude on Bladder Capacity in Spinal Cord Injured Subjects

Yeh

Lin

Chen

et al. 2019

Evidence-Based Complementary and Alternative Medicine

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Background/Purpose. Few studies have investigated the effects of changing the amplitude of dorsal genital nerve stimulation (GNS) on the inhibition of neurogenic detrusor overactivity in individuals with spinal cord injury (SCI). The present study determined the acute effects of changes in GNS amplitude on bladder capacity gain in individuals with SCI and neurogenic detrusor overactivity. Methods. Cystometry was used to assess the effects of continuous GNS on bladder capacity during bladder filling. The cystometric trials were conducted in a randomized sequence of cystometric fills with continuous GNS at stimulation amplitudes ranging from 1 to 4 times of threshold (T) required to elicit the genitoanal reflex. Results. The bladder capacity increased minimally and maximally by approximately 34% and 77%, respectively, of the baseline bladder capacity at 1.5 T and 3.2 T, respectively. Stimulation amplitude and bladder capacity were significantly correlated (R = 0.55, P = 0.01). Conclusion. This study demonstrates a linear correlation between the stimulation amplitude ranging from 1 to 4T and bladder capacity gain in individuals with SCI in acute GNS experiments. However, GNS amplitude out of the range of 1-4T might not be exactly a linear relationship due to subthreshold or saturation factors. Thus, further research is needed to examine this issue. Nevertheless, these results may be critical in laying the groundwork for understanding the effectiveness of acute GNS in the treatment of neurogenic detrusor overactivity.

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Long‐term course of sacral anterior root stimulation in spinal cord injured individuals: The fate of the detrusor

Abstract: The detrusor pressure during sacral anterior root stimulation decreases over time in SCI individuals. However, the changes do not seem to be clinically relevant during the first decade after surgery.

Cited by 13 publications

References 29 publications

Sexual dimorphism of detrusor function demonstrated by urodynamic studies in rhesus macaques

Sexual dimorphism of detrusor function demonstrated by urodynamic studies in rhesus macaques

Sacral Anterior Root Stimulation and Visceral Function Outcomes in Spinal Cord Injury–A Systematic Review of the Literature Over Four Decades

Effects of Genital Nerve Stimulation Amplitude on Bladder Capacity in Spinal Cord Injured Subjects

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