[Surgical treatment of spastic bladder paralysis in paraplegic patients. Sacral deafferentation with implantation of a sacral anterior root stimulator].

Because of incalculable incontinence, recurrent urinary infections and morphological and functional damage of the urinary tract, treatment of the spastic bladder is frequently problematic in patients with spinal cord lesions. The operative method presented is designed to stop the spastic detrusor action and to achieve controlled low-resistance voiding. Using either an intradural or an extradural approach, the afferent and efferent nerves of the parasympathetic spinal center are identified. The posterior roots S2 to S5 are cut. Electrodes are implanted at the anterior roots, and these allow transmitter-controlled stimulation. From September 1986 to September 1989, 45 patients were treated by this method. Sacral deafferentation (SDAF) at S2 to S5 helped and the spasticity of the bladder disappeared. The patients achieved continence and a bladder volume of more than 500 ml. The frequency of infection was reduced and renal insufficiency was corrected. The use of a special stimulation technique (sacral anterior root stimulation; SARS) allowed low-resistance voiding and avoided the problem of dyssynergia. Patient acceptance of this operation is high because of the resulting improvement in the quality of life.