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|Title:||Electrical stimulation techniques to restore bladder function|
|Source:||Lee, T. (1997). Electrical stimulation techniques to restore bladder function. Neurosurgery Quarterly 7 (4) : 264-272. ScholarBank@NUS Repository.|
|Abstract:||Neural control of the bladder and its sphincters is briefly reviewed. Both the afferent sensory and efferent motor fibers to the detrusor stem from the S2, 3, and 4 roots; the latter are from the sacral parasympathetic nervous system. Similarly, the somatic motor innervation of the external urethral sphincter is via the S2, 3, and 4 roots. The part that these roots play forms the anatomic basis for the idea that electrical stimulation of them might allow for regaining of control of the bladder detrusor and its sphincters. Pathologies affecting the spinal cord above the S2-4 segments are most amenable to treatment by electrical stimulation because of the intact sacral center and its nerve roots. The most common pathology for which electrodes are implanted is spinal cord trauma. Pathologies affecting the brain or the conus medullaris, cauda equina, or pelvic nerves are not amenable to treatment by stimulation. The possible sites for stimulation include the bladder wall, pelvic nerves, extrarural sacral roots, intradural sacral roots, and conus medullaris. There are theoretical reasons to doubt the usefulness of stimulation of the bladder wall, pelvic nerves, or conus medullaris. The reports in the literature on their use are few and far between. Stimulation of the sacral roots extradurally or intradurally, together with a deafferentation procedure, has been shown to be effective in regaining micturition and continence. There are slight advantages and disadvantages to the two methods. The two devices commonly used were designed by Tanagho and Brindley, respectively. The mode of stimulation and urodynamic principles of the two designs are vastly different. Tanagho reported his results of 22 cases in 1989. Brindley reported the results of the first 50 cases in 1986 and the first 500 cases in 1994. Of 477 patients known to be alive, 411 had continued to use the stimulators. Benefits included regained control of micturition and continence, diminished residual urine volume, fewer urinary tract infections, improved bladder compliance, less ureteric reflux, and regained bowel control and/or erection in some patients. Side effects included infection and cerebrospinal fluid leakage. Cable or implant failures were rare at a rate of one failure per 20 implant-years. Urinary continence might be improved by increasing sphincter tone, reducing the excitability of the micturition reflex, or increasing the storage capacity of the bladder. Use of electrical stimulation techniques alone to achieve these ends have not been successful thus far. A deafferentation procedure carded out at the time of implantation cures incontinence in most spinal cord- injured patients. The author concluded that Brindley's sacral anterior root stimulator has stood the test of time over the past 17 years; it is the most widely used device and has a success rate of 86%. Although in Europe this operation is commonly carded out by urologists, it is the author's opinion that the procedure, involving the opening of dura, sectioning of nerve roots, and application of electrodes to the nerve roots, should also be evaluated and discussed among neurosurgeons.|
|Source Title:||Neurosurgery Quarterly|
|Appears in Collections:||Staff Publications|
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