Early sacral neuromodulation prevents urinary incontinence after complete spinal cord injury

• Published in: Annals of neurology Vol. 67; no. 1; pp. 74 - 84
• Main Authors: Sievert, Karl-Dietrich, Amend, Bastian, Gakis, G., Toomey, P., Badke, A., Kaps, H.P., Stenzl, Arnulf
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.01.2010; Wiley-Liss
• Subjects: Adult; Biological and medical sciences; Electric Stimulation Therapy; Electrodes, Implanted; Follow-Up Studies; Functional Laterality; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Neurology; Peripheral Nerves - physiopathology; Prostheses and Implants; Sacrum; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - therapy; Time Factors; Traumas. Diseases due to physical agents; Treatment Outcome; Urinary Bladder - physiopathology; Urinary Incontinence - physiopathology; Urinary Incontinence - prevention & control; Young Adult; Urinary incontinence; Voiding dysfunction; Nervous system diseases; Sacrum; Urinary system disease; Spinal cord trauma; Central nervous system disease; Bladder disease; Urinary tract disease; Spinal cord disease; Neuromodulation
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.21814

Background 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. Methods 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. Results 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. Interpretation 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. Conclusion 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