Posterior sacral rhizotomy and intradural anterior sacral root stimulation for treatment of the spastic bladder in spinal cord injured patients.

Abstract

The efficacy of intradural sacral posterior rhizotomy combined with intradural sacral anterior root stimulation in the treatment of the neurogenic hyperreflexic bladder was evaluated. We reviewed 10 spinal cord injured patients who underwent surgery between September 1990 and February 1994. Bladder function was compared preoperatively and postoperatively. Intraoperative data on electrostimulation of the detrusor and striated muscles were analyzed. Stimulation of the anterior S3 and S4 roots was mostly used to empty the bladder (7 of 10 cases). Preoperative reflex incontinence disappeared in all patients postoperatively. Mean postoperative bladder capacity increases and mean postoperative post-void residual decreases were at least 340 ml. (p < 0.01) and 140 ml. (p < 0.01), respectively. Preoperative vesicorenal reflux disappeared in 2 and improved in 3 cases after sacral deafferentation. Autonomic hyperreflexia, which was present preoperatively in 6 patients, never disappeared but significantly improved after deafferentation. No major complications were noted postoperatively. Intradural sacral posterior rhizotomy combined with intradural sacral anterior root stimulation is a valuable method to treat the hyperreflexic bladder with incontinence resistant to conservative therapy in spinal cord injured patients. Autonomic hyperreflexia was decreased but not suppressed by posterior sacral rhizotomy.