TY - JOUR
T1 - Sacral root stimulation for controlled micturition
T2 - Prevention of detrusor-external sphincter dyssynergia by intraoperative identification and selective section of sacral nerve branches
AU - Haleem, A. S.
AU - Boehm, F.
AU - Legatt, A. D.
AU - Kantrowitz, A.
AU - Stone, B.
AU - Melman, Arnold
PY - 1993
Y1 - 1993
N2 - Electrical stimulation of the S2 nerve root can be used to produce detrusor contraction and voiding in patients with spinal cord injury, but concurrent stimulation of the external urethral sphincter causes detrusor- sphincter dyssynergia. This has been managed with a second surgical procedure, peripheral transection of the pudendal nerve. In this study, performed in dogs after spinal cord transection, laminectomy and ventral foraminotomy permitted tracing of the S2 root into the pelvis, where its branches were identified by electrical stimulation and urodynamic recording. The pudendal (somatic) branch was sectioned; the autonomic branch innervating the detrusor was preserved. Electrical stimulation of the proximal S2 root then produced detrusor contraction without contraction of the external urethral sphincter. This approach, which requires a single operation and spares pudendal nerve functions mediated by nerve roots other than S2, may enable a neurostimulator to provide effective voiding, without detrusor- external sphincter dyssynergia, in man.
AB - Electrical stimulation of the S2 nerve root can be used to produce detrusor contraction and voiding in patients with spinal cord injury, but concurrent stimulation of the external urethral sphincter causes detrusor- sphincter dyssynergia. This has been managed with a second surgical procedure, peripheral transection of the pudendal nerve. In this study, performed in dogs after spinal cord transection, laminectomy and ventral foraminotomy permitted tracing of the S2 root into the pelvis, where its branches were identified by electrical stimulation and urodynamic recording. The pudendal (somatic) branch was sectioned; the autonomic branch innervating the detrusor was preserved. Electrical stimulation of the proximal S2 root then produced detrusor contraction without contraction of the external urethral sphincter. This approach, which requires a single operation and spares pudendal nerve functions mediated by nerve roots other than S2, may enable a neurostimulator to provide effective voiding, without detrusor- external sphincter dyssynergia, in man.
KW - bladder
KW - dogs
KW - electric stimulation
KW - spinal cord
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U2 - 10.1016/S0022-5347(17)36460-1
DO - 10.1016/S0022-5347(17)36460-1
M3 - Article
C2 - 8501818
AN - SCOPUS:0027167713
VL - 149
SP - 1607
EP - 1612
JO - Investigative Urology
JF - Investigative Urology
SN - 0022-5347
IS - 6
ER -