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Sacral Neuromodulation in Lower Urinary Tract Dysfunction

  • J. R. Vignes
  • M. De Seze
  • E. Dobremez
  • P. A. Joseph
  • J. Guérin
Chapter
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 30)

Abstract

Vesico-urethral dysfunction is a major problem in daily medical practice due to its psychological disturbances, its social costs and its high impact on quality of life. Recently, sacral neuromodulation, namely the electrical stimulation of the sacral nerves, appears to have become an alternative for radical bladder surgery particularly in cases of idiopathic bladder overactivity. The mechanism of action is only partially understood but it seems to involve a modulation in the spinal cord due to stimulation of inhibitory interneurons.

Temporary sacral nerve stimulation is the first step. It comprises the temporary application of neuromodulation as a diagnostic test to determine the best location for the implant and to control the integrity of the sacral root. If test stimulation is successful, a permanent device is implanted. This procedure is safe in experienced hands.

So-called idiopathic bladder overactivity still the major indication for this technique. Patients not likely to benefit from the procedure were those with complete or almost complete spinal lesions, but incomplete spinal lesions seemed to be a potential indication. This technique is now also indicated in the case of idiopathic chronic retention and chronic pelvic pain syndrome.

When selection is performed, more than three-quarters of the patients showed a clinically significant response with 50% or more reduction in the frequency of incontinent episodes, but the results vary according to the author’s mode of evaluation. From the economic point of view, the initial investment in the device is amortized in the mid-term by savings related to lower urinary tract dysfunction.

Finally, this technique requires an attentive follow-up and adjustments to the electric parameters so as to optimize the equilibrium between the neurological systems.

Keywords

Bladder neurogenic electric stimulation therapy voiding dysfunction urinary urge incontinence urinary retention 

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Copyright information

© Springer-Verlag/Wien 2005

Authors and Affiliations

  • J. R. Vignes
    • 1
  • M. De Seze
    • 2
  • E. Dobremez
    • 3
  • P. A. Joseph
    • 2
  • J. Guérin
    • 1
  1. 1.Department of NeurosurgeryMedical School Hospital, Hôpital PellegrinBordeauxFrance
  2. 2.Neurorehabilitation UnitMedical School Hospital, Hôpital PellegrinBordeauxFrance
  3. 3.Department of Pediatric UrologyMedical School Hospital, Hôpital PellegrinBordeauxFrance

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