Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury

Krasmik, D.; Krebs, Jörg; Ophoven, Arndt van; Pannek, Jürgen

doi:10.1002/nau.22486

Cited by 46 publications

(46 citation statements)

References 32 publications

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“…Patients with Brindley stimulators neither performed intermittent catheterisation nor received treatment for detrusor overactivity. Given that the detrusor becomes areflexic after this procedure, 30 it was not surprising that this group of women did not suffer from UTIs during pregnancy.…”

Section: Discussionmentioning

confidence: 94%

Medical complications during pregnancy and childbirth in women with SCI in Switzerland

et al. 2015

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Study design: A retrospective interview study of mothers with spinal cord injuries (SCIs) who gave birth over the last 15 years. Objectives: To identify the medical complications of women with SCIs during pregnancy and childbirth in Switzerland and to describe how they dealt with these complications. Settings: Swiss Paraplegic Research in Nottwil, the University of Lausanne and participants' homes. Methods: Data were collected by self-reported questionnaires and descriptive analysis was conducted. Results: Seventeen women with SCIs who gave birth to 23 children were included. Thirteen of the women were paraplegics and four were tetraplegics. All of them practiced an independent bladder management. Three women changed their bladder management techniques during pregnancy. Five women reported an increased bladder evacuation frequency during pregnancy, and six women reported a new onset or increase in incontinence. We observed no significant increase in bowel dysfunction or skin breakdown due to their pregnancies. Ten women were hospitalised during the course of their pregnancies. Aside from urinary tract infections/ pyelonephritis, women were hospitalised for falls, hypertension, pneumonia, preeclampsia, pre-term labour or tachycardia. Conclusion:The results of our study clearly demonstrated that, although medical complications are not infrequent during pregnancy in women with SCIs, pregnancy and delivery in this group of women are possible without posing intolerable risks to the mothers or the children. Urological problems seemed to be the most frequent complication during pregnancy.

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Section: Discussionmentioning

confidence: 94%

Medical complications during pregnancy and childbirth in women with SCI in Switzerland

et al. 2015

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“…The treatment option can be used of a Brindley stimulator, a sacral anterior root stimulator device enabling patients with a complete SCI to empty their bladders. 7 Patients with such a stimulation are less likely to develop urinary tract infections. 7 Autonomic dysreflexia is one of the most dangerous complications during pregnancy in patients with tetraplegia or tetraparesis.…”

Section: Discussionmentioning

confidence: 99%

“…7 Patients with such a stimulation are less likely to develop urinary tract infections. 7 Autonomic dysreflexia is one of the most dangerous complications during pregnancy in patients with tetraplegia or tetraparesis. Our patient had in the past, mostly during the first 3 months after injury, several incidents of autonomic dysreflexia, but during pregnancy she had only two incidents of a mild blood pressure rise.…”

Section: Discussionmentioning

confidence: 99%

Problems with child care after successful pregnancy in a patient with spinal cord injury – a case study

Tarnacka¹,

Frasuńska²,

Wasiak³

et al. 2018

Pol. Ann. Med.

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I n t r o d u c t i o n : Pregnancy in spinal cord injury (SCI) patient's population israre. The problems with child care are also rarely described in the literature.A i m : To present a case of a woman with incomplete tetraplegia and problems during pregnancy and child care.C a s e s t u d y : A case of a 30-year-old SCI woman with C5 fracture due to a motor vehicle accident is described. She was admitted to our neurorehabilitation ward with severe tetraparesis and discharged able to walk with assistance. After discharge, the patient was referred by a senior physical medicine specialist in our outpatient clinic, and 4 years after her SCI, she got pregnant. Beyond acute clinical problems related to SCI, many chronic medical issues arose, such as orthostatic hypertension and constipation during her pregnancy. After 39 weeks of pregnancy, she was admitted for caesarean section because of somatosensory problems and received epidural analgesia. She gave birth to a male baby, weighing 3500 g. During the first weeks after delivery until now, she has had several problems with baby care due to limb paresis and spasticity, which she could not predict before.

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“…This result is reliable and reproducible when roots associated with bladder function are strictly selected. 10 Tripolar electrodes guarantee selective stimulation of each root, without any electrical diffusion. Each root was stimulated twice, once for global root stimulation to identify the level and bladder response and a second time to determine the anterior and posterior parts of the root.…”

Section: Validation and Reliability Of The Techniquementioning

confidence: 99%

Functional variability of sacral roots in bladder control

Carlucci

Wavasseur

Bénard

et al. 2014

SPI

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Object Sacral roots are involved in sensory, autonomic, and motor innervation of the lower limbs and perineum. Theoretically, it can be assumed that the S-3 root level innervates the bladder; however, clinical practice shows that this distribution can vary. Few researchers have studied this variability. Methods The authors conducted a retrospective study involving 40 patients who underwent surgery requiring an electrophysiological exploration of the sacral roots. They performed stimulations for the monitoring of muscular (3 Hz, 1 V) and bladder responses under cystomanometry (30 Hz, 10 V). Results Although the S-3 roots were involved in bladder innervation in all cases, they were exclusively involved (i.e., the only nerve roots involved) in only 8 of 40 cases. In the remaining 32 cases, other sacral nerve roots were involved. The most common association was S-3+S-4 (12 cases), followed by S-2+S-3 (6 cases), S-2+S-3+S-4 (5 cases), and S-3+S-4+S-5 (2 cases). Stimulation of S-2 could sometimes induce bladder contraction (15 cases, 40%); however, the amplitude was often low. S-4 nerve roots were involved in 24 of 40 cases (60%) in the bladder motor function, whereas S-5 roots were only involved 7 times (17%). Occasionally, we noticed a horizontal asymmetry in the response, with a predominant response from the right side in 6 of 7 cases, always with a major S-3 response. Conclusions This is the first study showing a significant horizontal and vertical variability in the functional distribution of sacral roots in bladder innervation. These results show the variability of cauda equina syndromes and their forensic implications. These data should help with the monitoring of sacral roots and the performance of several tasks during surgery, including neurostimulation and neuromodulation.

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Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury

Abstract: Sacral deafferentation and SARS are an effective treatment option for refractory NLUTD in patients with complete SCI, despite a substantial long-term complication rate.

Cited by 46 publications

References 32 publications

Medical complications during pregnancy and childbirth in women with SCI in Switzerland

Medical complications during pregnancy and childbirth in women with SCI in Switzerland

Problems with child care after successful pregnancy in a patient with spinal cord injury – a case study

Functional variability of sacral roots in bladder control

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