The role of denervation in the treatment of detrusor instability

The bladder can function autonomously after complete denervation [Denny Brown and Robertson, 1933] and the activity of the spastic paraplegic bladder may be improved after extensive anterior rhizotomy [Munro, 1945]. Because of such observations denervation (better termed decentralisation) has been used sporadically over the last 40 years to control bladder overactivity. This denervation may be attempted at many levels: Intramural, by hyperbaric vesical distension [Dunn et al, 1974]. Intramural, by vesical transection [Essenhigh and Yeates, 1973] or myotomy [Mahony and Laferte, 1972]. Paravesical—transabdominal [Worth and Turner‐Warwick, 1973], transvaginal [Ingelman‐Sundberg, 1959], or transvesical [Mundy and Stephenson, 1984]. Parasacral [Theirmann, 1952]. Transsacral extradural [Meirowsky and Scheibert, 1950; Torrens and Griffith, 1976; Rocks wold et al, 1973]. Lumbosacral intradural [Toczek et al, 1978]. From the analysis of results in a number of relatively small series [Torrens and Hald, 1979], certain general conclusions can be drawn and these are listed below.