| Sacral bladder denervation for treatment of detrusor hyperreflexia and autonomic dysreflexia. | |
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MedLine Citation:
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PMID: 11445474 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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M Hohenfellner; J Pannek; U Bötel; S Dahms; J Pfitzenmaier; J Fichtner; G Hutschenreiter; J W Thüroff |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Urology Volume: 58 ISSN: 1527-9995 ISO Abbreviation: Urology Publication Date: 2001 Jul |
Date Detail:
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Created Date: 2001-07-10 Completed Date: 2001-08-09 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0366151 Medline TA: Urology Country: United States |
Other Details:
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Languages: eng Pagination: 28-32 Citation Subset: IM |
Affiliation:
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Department of Urology, Johannes Gutenberg-University, Mainz, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Autonomic Dysreflexia / etiology, surgery* Cystostomy Female Follow-Up Studies Humans Lumbar Vertebrae Male Middle Aged Muscle Hypertonia / etiology, surgery* Paraplegia / etiology Quadriplegia / etiology Reflex, Abnormal Rhizotomy / methods* Sacrum Spinal Cord Injuries / complications Treatment Outcome Urinary Bladder / innervation* Urinary Catheterization Urinary Incontinence / etiology, prevention & control Urinary Tract Infections / etiology, prevention & control |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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