Neural stimulation in the management of the neuropathic bladder

Abstract

The ideal management of the neuropathic bladder would result in low-pressure storage of urine with controlled and complete emptying of the bladder. With this, the patient should be continent and free of any urine-collecting appliance, without infection and with preservation of upper-tract function. Sacral anterior root stimulation has been a major advance in the treatment of voiding dysfunction in the neuropathic bladder. In principle, the system requires an intact sacral reflex arc where storage is facilitated by extensive sacral dorsal root rhizotomy to produce an areflexic bladder and to prevent unwanted reflex responses, while stimulation of the sacral anterior roots gives rise to a detrusor contraction and bladder emptying. Additional advantages may include implant-driven penile erections and defaecation. The success rates for implant-driven micturition without incontinence have been high and the great majority of patients will have an improved quality of life having undergone such treatment. Sacral anterior root stimulation is now a viable option in the management of neuropathic voiding dysfunction. Show more