Sacral bladder denervation for treatment of detrusor hyperreflexia and autonomic dysreflexia.

OBJECTIVES: Detrusor hyperreflexia after spinal cord injury may cause urinary incontinence and chronic renal failure. In patients refractory to conservative treatment and not eligible for ventral sacral root stimulation for electrically induced micturition, we investigated the therapeutic value of sacral bladder denervation as a stand-alone procedure.

METHODS: Nine patients (8 men and 1 woman) between 21 and 58 years old (mean 30.2) with traumatic suprasacral spinal cord lesions underwent sacral bladder denervation for treatment of detrusor hyperreflexia and/or autonomic dysreflexia.

RESULTS: Detrusor hyperreflexia and autonomic dysreflexia were eliminated in all cases. Bladder capacity increased from 177.8 +/- 39.6 to 668.9 +/- 64.3 mL; intravesical pressure decreased from 89.3 +/- 19.1 to 20.2 +/- 2.7 cm H(2)O. For facilitating clean intermittent catheterization (CIC), 4 patients received a continent vesicostomy in a second-stage procedure; one of them in combination with bladder augmentation. Four patients empty their bladder by way of urethral CIC. One completely tetraplegic patient has an indwelling urethral catheter. In the 5 patients with autonomic dysreflexia, the systolic blood pressure was lowered from 196 +/- 16.9 to 124 +/- 9.3 mm Hg and the diastolic blood pressure from 114 +/- 5.1 to 76 +/- 5.1. The annual frequency of urinary tract infections decreased from 9 +/- 1.2 to 1.8 +/- 0.7. In all patients, renal function remained stable.

CONCLUSIONS: In selected patients with detrusor hyperreflexia and/or autonomic dysreflexia, sacral bladder denervation is a valuable treatment option. It is only moderately invasive in nature, requires neither sophisticated nor expensive medical equipment, and is an attractive alternative to urinary diversion using intestinal segments.