Sacral Denervation

When detrusor hyperreflexia post SCI does not respond to conservative treatment, and patients are not eligible for ventral sacral root stimulation for electrically induced micturition, sacral bladder denervation may be considered as a stand-alone procedure to treat urinary incontinence and AD.

Discussion

Three level 4 studies (aggregate n=459) (Schurch et al. 1998; Hohenfellner et al. 2001; Kutzenberger 2007) examining sacral denervation have reported conflicting results in response to this procedure. Hohenfellner et al. (2001) reported that sacral bladder denervation is a valuable treatment option for eliminating detrusor hyperreflexia and AD in all 9 of their participants. However, in Schurch et al.’s 10 participants, it was shown that complete bladder deafferentation does not abolish AD during bladder urodynamic investigations. In a review of 440 patients, Kutzenberger saw sacral deafferentation eliminate AD in 438 of them.

Conclusion

There is level 4 evidence (from one pre-post study and one case series study: Hohenfellner et al. 2001; Kutzenberger 2007) that sacral deafferentation may be effective in preventing AD.