Study design: Cross-sectional descriptive study. Objectives: To assess long-term effects and quality of life (QoL) of using sacral anterior root stimulation (SARS) in spinal cord injured patients. Setting: Neurosurgical and Urological Departments of a large teaching hospital and a large rehabilitation centre in the Netherlands. Methods: In all, 42 patients with complete spinal cord injury (SCI) implanted between 1987 and 2000 were included. A questionnaire was constructed to determine complications, technical failures and personal experiences of the patients. The Qualiveen questionnaire was used and the outcome was compared with data obtained from a reference group of 400 SCI patients with neurogenic bladder problems not using the bladder controller. The Qualiveen questionnaire measures disease-specific aspects in four domains with respect to limitations, constraints, fears and feelings and general QoL aspects, suitable for use in SCI patients with urinary disorders. Results: The results of 37 patients are presented. Our results with the bladder controller with respect to medical and technical complications and infection rates are similar to the results presented by others. From users' experiences, the most important advantages reported were a decreased infection rate (68%), improved social life (54%) and continence (54%). Comparison of the obtained results of our patient group with the Qualiveen questionnaire with a reference group not using the bladder controller indicates that the specific impact of urinary disorders in the four domains on QoL is reduced and that general QoL is improved. Conclusion: SARS is effective and safe for neurogenic bladder management in patients with complete SCI. Users' experiences are positive. Furthermore, this therapy seems to reduce the effects of urinary-disorder-specific QoL aspects, and to increase the QoL in general.

The Brindley bladder stimulator delivers intermittent stimulation to the anterior sacral roots. The stimulus parameters can be adjusted and set specifically for individuals. Its primary purpose is to improve bladder emptying, thereby to eliminate urinary infection and to preserve kidney function. It also assists in defecation and enables male patients to have a sustained full erection. In our unit so far 38 patients with a complete spinal cord lesion have received a Brindley bladder stimulator implant. One patient died 2 weeks after the surgery due to pulmonary embolism. Two other patients died due to unrelated causes during the follow up period. They used their implants for less than 1 year. Results relating to these 2 patients and the remaining 35 patients who regularly use their implant are presented. The follow-up period ranged from 3 months to 12 years. Residual urine volumes are substantially reduced in all patients; in 24 patients the residual urine volume is less than 30 ml. All patients have increased bladder capacity. Thirty-one patients are continent. Out of 33 males 29 can achieve a sustained full erection using the stimulator. Twenty-seven patients use the implant for bowel function. The following complications were encountered: (1.) Cerebro-spinal fluid collection occurred around the implant in 3 patients during the post-operative period; (2.) Receiver failure occurred in 3 patients. A successful replacement with a new receiver block was carried out in these cases. It is concluded that the use of a bladder stimulator in selected patients gives long term favourable results.

The true incidence of posterior urethral valves is unknown. They may cause major or minor urinary tract malfunction, reflecting the broad spectrum of degree of congenital malformation. Of 124 boys with posterior urethral valves 76 per cent had only minor secondary abnormalities and 24 per cent had secondary problems, such as large paraureteral diverticula, high grade reflux with upper tract damage, megaureter, hydronephrosis and uremia. The diagnosis of posterior urethral valves was based on voiding cystourethrography and endoscopy. Only types I and III values were found in our study. Except for 1 case, the valves were fulgurated endoscopically. Upper tract drainage was necessary in only 4 cases and kidney transplantation was required in 1. Most patients were cured by valve fulguration. Reflux disappeared in more than 50 per cent. Urodynamic studies in 16 patients with persistent complaints of diurnal and nocturnal enuresis revealed further bladder dysfunction.

A Finetech-Brindley bladder controller was implanted in 17 patients with a complete lesion of the spinal cord. During a microscopic procedure in the cauda equina, the sacral roots were identified and the posterior components of the S2, S3 and S4 roots were cut. The stimulator was placed intradurally around the anterior components of the S2, S3, S4 roots and the S5 root. Our patients have now been followed-up for periods varying between 1 and 6 years. In all 17 patients, the bladder capacity has been increased; 16 patients have a residual volume of less than 30 ml, urinary tract infection is rare; 12 patients are fully continent. All male patients can achieve a full sustained erection by means of the implant and 13 patients are using the implant for bowel function. The method has no significant harmful effects or complications.

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