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Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury
Author(s) -
Sievert KarlDietrich,
Amend Bastian,
Gakis G.,
Toomey P.,
Badke A.,
Kaps H.P.,
Stenzl Arnulf
Publication year - 2010
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.21814
Subject(s) - medicine , spinal cord injury , urinary system , urinary incontinence , urology , spinal cord , urinary continence , neuromodulation , urinary bladder , detrusor muscle , overactive bladder , surgery , anesthesia , central nervous system , prostate , prostatectomy , pathology , alternative medicine , psychiatry , cancer
Background The study aim was to investigate potential influences on human nerves and pelvic organs through early implantation of bilateral sacral nerve modulators (SNMs) in complete spinal cord injury (SCI) patients during the acute bladder‐areflexia phase. Methods Ten patients with neurologically‐confirmed complete spinal cord lesions (SCLs) were provided with bilateral SNMs during the phase of atonic‐detrusor muscle. Modulation was achieved by two electrodes implanted into each S 3 ‐foramen. Six patients declined and served as controls. The mean follow‐up was 26.2 months. Results Videourodynamics (VU) confirmed detrusor acontractility, resulting in urinary continence as well as significant reductions in urinary tract infections (UTIs). Bowel movements did not require oral laxatives; additional preprogrammed parameters achieved erections for intercourse. Interpretation Early SNM implantation in SCI patients may revolutionize neurogenic lower urinary tract (LUT) dysfunction management; it prevented detrusor overactivity and urinary incontinence, ensured normal bladder capacity, reduced UTI rates, and improved bowel and erectile functionality without nerve damage. Conclusion Future SCI investigations will be conducted to evaluate the potential benefits of even earlier SNM placement to progressively enhance pelvic organ functionality. This new approach may provide important clues required for assessing whether neuronal information is passed through the sympathetic trunk ganglion to the brain after complete SCI. Further investigations are needed to determine if functional magnetic resonance imaging (fMRI) might be helpful for analyzing changes in brain function in patients with SNMs and those taking antimuscarinics. ANN NEUROL 2010;67:74–84