ACUTE AND CHRONIC USE OF A SACRAL POSTERIOR AND ANTERIOR NERVE ROOT STIMULATOR TO INCREASE BLADDER CAPACITY IN SPINAL CORD INJURY

Abstract Neuromodulation by stimulation of pudendal afferents has been shown to increase bladder capacity in spinal cord injury. It may be an alternative to the posterior rhizotomy of the sensory roots from S 2 to S 4 that normally accompanies a Finetech-Brindley Sacral Anterior Root Stimulator, resulting in the loss of reflex erections. We describe two patients in whom continuous low level stimulation of the mixed sacral nerves via an extradural Finetech-Brindley device resulted in effective suppression of detrusor hyperreflexia. Neuromodulation in the laboratory increased bladder by up to 300% using either continuous or conditional stimulation, and neuromodulation at home resulted in a bladder capacity comparable to that achieved with oxybutinin. Although these results suggest that neuromodulation may be a replacement for posterior rhizotomy, persisting detrusorsphincter dyssynergia may affect stimulator-driven emptying and is probably the reason for incomplete voiding in the patients described in this study