Long-term course of sacral anterior root stimulation in spinal cord injured individuals: The fate of the detrusor

AIMS

To investigate the long-term course of the detrusor pressure during sacral anterior root stimulation in spinal cord injury (SCI) patients.

METHODS

Retrospective evaluation of 111 patients who had undergone sacral deafferentation and implantation of an anterior root stimulator at a single SCI rehabilitation center with a minimum follow-up time of 5 years.

RESULTS

The median follow-up time was 11.7 years (range 5.0-24.9 years). The maximum detrusor pressure (Pdet_max) during stimulation was higher in men compared to women (P = 0.0004) and decreased over time (P = 0.0006). However, there were no significant (P ≥ 0.06) differences in the median Pdet_max during stimulation between the first measurement time point and any follow-up time point. The Pdet_max during stimulation decreased from 62 cmH₂ O (95%CI 57-73 cmH₂ O) to 53 cmH₂ O (95%CI 47-69 cmH₂ O) (P = 0.9). The time had also a significant effect on Pdet_max during the storage phase (P < 0.0001) and bladder compliance (P = 0.0007). The Pdet_max during the storage phase decreased, whereas bladder compliance increased during the follow-up period. There were no significant (P ≥ 0.1) changes over time in bladder capacity, the number of daily stimulations and the residual urine volume after voiding.

CONCLUSIONS

The detrusor pressure during sacral anterior root stimulation decreases over time in SCI individuals. However, the changes do not seem to be clinically relevant during the first decade after surgery.

Charcot arthropathy of the spine in spinal cord injured individuals with sacral deafferentation and anterior root stimulator implantation

AIMS

To investigate the occurrence of Charcot spinal arthropathy (CSA) after sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) of the bladder in patients suffering from neurogenic lower urinary tract dysfunction (NLUTD) as a result of spinal cord injury (SCI).

METHODS

Retrospective evaluation of patients who had undergone SDAF/SARS at a single SCI rehabilitation centre. The occurrence rate of stimulation dysfunction was determined, and the medical records and radiological images of the included patients were examined for CSA. The diagnosis of CSA was based on radiological criteria. The occurrence rate of CSA was estimated for all SARS patients and for those with SARS dysfunction, and the odds ratios (OR) for the occurrence of CSA were calculated.

RESULTS

In 11/130 SARS patients (8%), CSA was observed a median 8 years (95% CI 5-16 years) after SDAF/SARS or a median 21 years (95% CI 9-41 years) after SCI had occurred. The median follow-up time was 14 years (range 6-25 years). The proportion of patients with CSA was significantly (P = 0.036) greater in patients with SARS dysfunction (7/41) than in patients without SARS dysfunction (4/89). The odds of CSA were four times greater (OR 4.3, 95% CI 1.0-21.5) in patients with SARS dysfunction compared to those without. Furthermore, the odds of CSA were 20 times greater (OR 20.2, 95% CI 8.4-47.0) in patients with SARS compared to those without.

CONCLUSIONS

Charcot spinal arthropathy should be considered a potential long-term complication of SDAF/SARS, and spinal instability is a possible reason for SARS dysfunction.

Prostate volume in male patients with spinal cord injury: a question of nerves?

OBJECTIVE

To assess the influence of standardized complete surgical deafferentation of the lower urinary tract by sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) on prostate volume in men with spinal cord injury (SCI).

PATIENTS AND METHODS

In a prospective study, the prostate volume of men with SCI who underwent SDAF/SARS was measured using transrectal ultrasonography. The prostate volumes of these men were compared with those of men with complete SCI but who did not undergo SDAF/SARS, those of men with incomplete SCI, and those of a historical sample of able-bodied men.

RESULTS

The median [25th;75th percentile] prostate volume of men who underwent SDAF/SARS (20.0 [14.0; 29.0]) and of men with complete SCI who did not undergo SDAF/SARS (20.0 [16.5; 29.0]) was significantly smaller than in the reference group (25.0 [5.0; 84.0]). The mean prostate volume was associated with age in the reference group (r = 0.185; P < 0.001) and in men with incomplete SCI (r = 0.284; P = 0.031), but not in men with complete SCI, irrespective of SDAF/SARS.

CONCLUSIONS

The prostate volume of men with complete SCI was significantly smaller than that of able-bodied men. Our data imply that sustained central innervation of the prostate plays an important role in prostate growth.