Neural stimulation for control of voiding dysfunction: a preliminary report in 22 patients with serious neuropathic voiding disorders.

Our experience with electrode implantation has demonstrated that the most successful combination to achieve continence and promote bladder evacuation is implantation on the ventral component of S3 or S4 and extensive dorsal rhizotomy with selective peripheral neurotomy. Of 22 patients with serious neuropathic voiding disorders treated during the last 6 years results were available for evaluation in 19 (2 were lost to followup and 1 was withdrawn from the protocol because of an infection at the receiver site). In 8 patients (42 per cent) complete success was achieved. These patients have regained reservoir function, are completely dry and void with electrical stimulation. The voiding is synchronous, with low voiding pressure and low residual urine volumes. Ten patients qualify as having partial success. They have regained reservoir function and are dry. One patient voids partially with stimulation, 5 depend on intermittent self-catheterization, 1 regained reservoir function and received an artificial sphincter, and 3 are catheter-dependent (these 3 all had been incontinent preoperatively despite continuous catheter drainage). The remaining patient entered the program long after a cerebrovascular accident and treatment has failed owing to poor selection. The stimulation parameters, once stabilized, did not need to be increased, and neither the surgical manipulation of the sacral roots nor the electrode implantation resulted in further neural loss in any patient.