The first 500 patients with sacral anterior root stimulator implants: general description

Study design: Prospective monocentric follow-up study. Objectives: To assess long-term functional and urodynamic results of augmentation enterocystoplasty in spinal cord injury (SCI) patients with detrusor hyperre¯exia and re¯ex incontinence who failed to respond to conservative treatment. Settings: Department of Urology (PitieÂ -SalpeÂ trieÁ re Hospital, Paris, France), Department of Neurological Rehabilitation (Raymond PoincareÂ Hospital, Garches, France), Assistance Publique ± Hopitaux de Paris, University Paris VI and V, France. Methods: Prospective study of 17 SCI patients (four above T6 level, nine between T6 and T12, and four below T12) with history of refractory urge incontinence to pharmacotherapy. Partial cystectomy (subtrigonal for 15) was performed with Hautmann enterocystoplasty (15) or detubularized clam cystoplasty (two). Results: Mean follow-up was 6.3+3.8 years (range 1.25 ± 10.5 years). Fifteen of 17 (88.5%) patients were completely continent under self clean intermittent catheterization (CIC) (mean 4.6/day, range 4 ± 7). The remaining two patients with pudendal nerve denervation had persistent stress urinary incontinence. No operative complications were noted. Long-term complications included recurrent pyelonephritis for one patient. Maximal cystometric capacity increased from 174.1+103.9 to 508.1+215.8 ml (P50.05). Maximal end ®lling pressure decreased from 65.5+50.2 to 18.3+7.9 cm H 2 O (P50.05). Conclusion: Urodynamic evaluation and clinical assessment demonstrate long-term success of augmentation enterocystoplasty in an homogeneous population (SCI) without delayed complications in SCI patients. Spinal Cord (2000) 38, 490 ± 494

Section: Discussionmentioning

confidence: 99%

Long-term results of augmentation cystoplasty in spinal cord injury patients

Chartier-Kastler

Mongiat-Artus

et al. 2000

“…3,4 Sacral anterior root stimulators and posterior rhizotomy are mainly indicated for patients with complete neural de®cits. 5 Thus, there remain patients in which known treatments for DSD are insu cient or excessively invasive.…”

Section: Introductionmentioning

confidence: 99%

Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease

Petit

Wiart²,

Gaujard³

et al. 1998

134

We studied the e cacy of endoscopic injection of Botulinum A toxin (150 I.U. Dysport 1 ) in the treatment of detrusor-sphincter dyssynergia in 17 patients with spinal cord disease. One month after the injection, the postvoiding residual urine volume (7176 ml, P50.001), the bladder pressure on voiding (719 cm water, P50.01), and the urethral pressure (724 cm water, P50.001) were signi®cantly decreased. The modality of voiding was improved in 10 patients (ie micturition by suprapubic tapping was easier to induce, discontinuation of indwelling catheter use, or decrease in frequency of intermittent catheterizations). The tolerance of the treatment was excellent. The therapeutic e ect lasted 2 to 3 months on the average. The low doses used in this study probably explain in part why the treatment sometimes failed. Botulinum A toxin could become an alternative treatment for detrusorsphincter dyssynergia in certain patients, notably in those who are refractory to sphincterotomy or in patients, such as those who are tetraplegic, and who are incapable of performing intermittent self-catheterization.

“…In 12 of the patients the second failure was repaired, and in nine a new extradural stimulator was implanted. Three of the twelve stimulators that had been repaired twice later failed a third time and were again repaired (2) or replaced (1). Two extradural stimulators put in to replace failed intrathecal ones have failed and been repaired.…”

Section: Failures Of the Implantmentioning

confidence: 99%

The first 500 sacral anterior root stimulators: implant failures and their repair

Brindley

1995

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