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Predictive factors of stress incontinence after posterior sacral rhizotomy
Author(s) -
Chinier Eva,
Egon Guy,
Hamel Olivier,
Lemée JeanMichel,
PerrouinVerbe Brigitte
Publication year - 2016
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.22693
Subject(s) - medicine , rhizotomy , urinary incontinence , surgery , stress incontinence , neck of urinary bladder , urethral sphincter , anesthesia , urinary bladder , spinal cord , psychiatry
Aims The Brindley procedure, used since the 1980s, consists of implantation of a stimulator for sacral anterior root stimulation combined with a posterior sacral rhizotomy to enable micturition. Patients suitable for the procedure are patients with detrusor overactivity and a complete spinal cord lesion with intact sacral reflexes. S 2 to S 4 posterior sacral rhizotomy abolishes sacral hyperreflexia and may lead to decreased urethral closure pressure and loss of reflex adaptation of continence, leading to stress incontinence. Methods In this retrospective study of 96 patients from Nantes or Le Mans, implanted with a Finetech‐Brindley stimulator, we analyzed the incidence of stress incontinence one year after surgery and looked for predictive factors of stress incontinence one year after posterior sacral rhizotomy: age, gender, level of injury between T 10 and L 2 , previous urethral surgery, incompetent bladder neck, Maximum Urethral Closure Pressure before surgery less than 30 cmH 2 O, compliance before surgery less than 30 ml/cmH 2 0. Patients with persistent involuntary detrusor contractions with or without incontinence after surgery were excluded. Results One year after surgery, 10.4% of the patients experienced stress incontinence. Urethral closure pressure was significantly decreased by 18% after posterior sacral rhizotomy ( P = 0.002). This study highlights the only significant predictive factor of stress incontinence after rhizotomy: incompetent bladder neck ( P = 0.002). Conclusions As screening of patients undergoing the Brindley procedure is essential to achieve optimal postoperative results, on the basis of this study, we propose preoperative assessment to select the population of patients most likely to benefit from the Brindley procedure. Neurourol. Urodynam. 35:206–211, 2016 . © 2014 Wiley Periodicals, Inc.