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PHYSIOLOGICAL
BLADDER EVACUATION BY SELECTIVE SACRAL ROOT STIMULATION USING THE
SINUSOIDAL SIGNAL AND SPECIFIC ORGAN FREQUENCY
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Authors:
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Karl-Dietrich Sievert1,
2), Curtis A Gleason1), Klaus-Peter Jünemann3) and Emil A Tanagho1)
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Institution:
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1) University of California,
San Francisco, School of Medicine Department of Urology 2) Westfälische
Wilhelms-Universität Münster Klinik und Poliklinik für Urologie
3) Ruprecht-Karls Universität Heidelberg, Klinikum Manneim, Klinik
und Poliklinik für Urologie
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Aims of Study
Patients with supraconal spinal cord injury suffer the loss of bladder control
resulting in detrusor hyperflexia and sphincter spasm. Sacral anterior root
stimulation (SARS) evacuates the bladder but the sacral deafferentiation (SDAF)
is needed to eliminate the bladder hyperreflexia to have normalized bladder
filling. The common stimulation parameters coactivate the detrusor and the external
urethral sphincter simultaneously, known as detrusor-sphincter-dyssynergia.
The resulting post-stimulus-voiding is not physiological. We investigated for
endorgan specific (detrusor or sphincter) stimulation parameters.
Methods
The common rectangular pulse and the sinusoidal signal with a variety of parameters
were investigated in 20 acute male dogs, at least one year old, while stimulating
the spinal S1 - S3 anterior roots extradurally or intradurally. The other parameters
were: Stimulation frequency, stimulation voltage, uni- vs. bilateral stimulation
and bladder filling. New torpedo shaped bipolar electrodes were used; adjusted
to the nerve diameter (extra- or intradural placement).
Results
The best results were recorded by using intradural bilateral sinusoidal signal.
Sphincter was fatigued by prestimulating S2 with 104±71 Hz and 0.8±0.3 V for
10 - 15 sec. Afterwards, additional S3 stimulation with 16±12 Hz and 0.4±0.3
V caused detrusor pressure of 28.7±3.0 cm H2O above the sphincter pressure without
new sphincter pressure increase.
Conclusions
Sacral anterior root stimulation with end organ specific parameters, can be
used to fatigue the sphincter. Induced sphincter fatiguing resembles to the
physiological sphincter relaxation. This decreases the micturation baldder outlet
resistants from the start of the induced micturation on. Organ specific parameters
SARS (OSP-SARS) might prevent further detrusor hyperplasia.