Affiliations: Neuro-Urological Laboratory, Department of Urology,
Klinikum Mannheim, Mannheim, Germany
Note: [] Correspondence to: K.-P. Jünemann, M.D., Department of
Urology, Klinikum Mannheim, Theodor-Kutzer-Ufer, D-68135 Mannheim, Germany;
Tel.: +49-621-383-2629; Fax: +49-621-377274
Abstract: The combination of sacral anterior root stimulation (SARS) and
posterior rhizotomy is a successful procedure for the restoration of bladder
function after supraconal spinal cord injury. Today, complete posterior
rhizotomy has become part of the standard therapy. Conventional SARS leads to
simultaneous activation of both the detrusor muscle and the external urethral
sphincter. We evaluated the possibilities of different neurostimulation
techniques to overcome stimulation-induced detrusor-sphincter-dyssynergia and
to achieve physiological voiding. Selective detrusor activation improves
current sacral neurostimulation of the bladder, including the
poststimulus voiding principle. Selec-tive neurostimulation is
possible in the following techniques: anodal block, high-frequency block,
depolarizing prepulses, sinusoidal pulses and cryoblock. The anodal block
technique and cryotechnique are excellent methods for selective bladder
activation to avoid detrusor-sphinc-ter-dyssynergia and thus improve
stimulation-induced voiding. Our experience has shown that future modern
selective bladder neurostimulation systems will be based on either the anodal
block technique or the cryotechnique.
