Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury
Version of Record online: 4 AUG 2009
Copyright © 2010 American Neurological Association
Annals of Neurology
Volume 67, Issue 1, pages 74–84, January 2010
How to Cite
Sievert, K.-D., Amend, B., Gakis, G., Toomey, P., Badke, A., Kaps, H.P. and Stenzl, A. (2010), Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury. Ann Neurol., 67: 74–84. doi: 10.1002/ana.21814
- Issue online: 23 FEB 2010
- Version of Record online: 4 AUG 2009
- Accepted manuscript online: 4 AUG 2009 12:00AM EST
- Manuscript Accepted: 28 JUL 2009
- Manuscript Revised: 6 JUL 2009
- Manuscript Received: 27 NOV 2008
The study aim was to investigate potential influences on human nerves and pelvic organs through early implantation of bilateral sacral nerve modulators (SNMs) in complete spinal cord injury (SCI) patients during the acute bladder-areflexia phase.
Ten patients with neurologically-confirmed complete spinal cord lesions (SCLs) were provided with bilateral SNMs during the phase of atonic-detrusor muscle. Modulation was achieved by two electrodes implanted into each S3-foramen. Six patients declined and served as controls. The mean follow-up was 26.2 months.
Videourodynamics (VU) confirmed detrusor acontractility, resulting in urinary continence as well as significant reductions in urinary tract infections (UTIs). Bowel movements did not require oral laxatives; additional preprogrammed parameters achieved erections for intercourse.
Early SNM implantation in SCI patients may revolutionize neurogenic lower urinary tract (LUT) dysfunction management; it prevented detrusor overactivity and urinary incontinence, ensured normal bladder capacity, reduced UTI rates, and improved bowel and erectile functionality without nerve damage.
Future SCI investigations will be conducted to evaluate the potential benefits of even earlier SNM placement to progressively enhance pelvic organ functionality. This new approach may provide important clues required for assessing whether neuronal information is passed through the sympathetic trunk ganglion to the brain after complete SCI. Further investigations are needed to determine if functional magnetic resonance imaging (fMRI) might be helpful for analyzing changes in brain function in patients with SNMs and those taking antimuscarinics. ANN NEUROL 2010;67:74–84