Sacral anterior root stimulators for bladder control in paraplegia: the first 50 cases.

TLDR

The first 50 patients who have received sacral anterior root stimulator implants are presented, with follow‑up of from 1 to 9 years. Sacral anterior root stimulators were implanted in 50 paraplegic patients and followed for 1–9 years. Of the 49 surviving patients, 43 regularly use the implants, most report high satisfaction, residual urine is markedly reduced, 10 of 12 women and most men achieve continence, voiding pressure is kept below 90 cm H₂O, four of seven patients with pre‑operative ureteric reflux resolved, bladder imaging is stable or improved with only two upper‑tract deteriorations, and complications include CSF leaks, post‑operative urinary infections, and accidental root damage, which is usually reversible for anterior roots but not for posterior roots.

Abstract

The first 50 patients who have received sacral anterior root stimulator implants are presented, with follow-up of from 1 to 9 years. Forty-nine are alive and 43 are regularly using their implants for micturition. Of the 49 living, 39 are "very pleased, without significant reservations", six are pleased on balance but have reservations, and four are dissatisfied. Residual urine volumes are substantially reduced in all patients who are using their implants. Ten of the 12 female patients and the majority of male patients have become continent. The voiding pressure in implant-driven micturition can be regulated by adjusting the stimulus parameters, and is always kept below 90 cm H2O. Of seven patients with ureteric reflux before operation, four have ceased to reflux and the other three are unchanged. Changes in the radiographic appearances of the bladder have been favourable or zero, but there have been two cases of deterioration in the upper urinary tracts. Significant harmful effects have been CSF leaks, urinary infections following post-operative urodynamic study, and accidental damage to roots. Anterior roots nearly always recover from accidental damage, and posterior roots do not.