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Urinary Continence in Spinal Injury Patients Following Complete Sacral Posterior Rhizotomy
Author(s) -
MacDONAGH R. P.,
FORSTER D. M. C.,
THOMAS D. G.
Publication year - 1990
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1990.tb07194.x
Subject(s) - rhizotomy , medicine , urinary continence , spinal cord injury , urinary system , urinary incontinence , surgery , anatomy , spinal cord , prostate , prostatectomy , dorsum , cancer , psychiatry
Summary— Complete sacral posterior rhizotomy was carried out in 15 spinal injury patients in conjunction with implantation of sacral anterior root stimulators. All patients were incontinent preoperatively and had video‐pressure cystometry before and at regular intervals after surgery. Detrusor hyper‐reflexia was totally abolished in all but 1 patient following rhizotomy and 87% no longer require any form of incontinence appliance. Deafferentation produced adverse changes in vesicourethral function and even when rhizotomy was complete, continence could not be guaranteed. The pre‐operative state of the bladder neck and distal sphincter mechanism had an important bearing on future continence and those patients with a closed bladder neck and no previous sphincterotomy had the greatest chance of becoming continent after deafferentation. The majority of patients in this series are now fully continent, representing a transformation in their quality of life; it is recommended, however, that to optimise the success of rhizotomy precise preoperative evaluation and selection of patients are essential.