Introduction: The mechanism of micturition is controlled by a complex neural system at the brain and spinal cord. Although sacral neuromodulation (SNM) is primarily believed to act at the peripheral spinal level, there is evidence suggesting that SNM also act at central brain centres involved in bladder function control. Herein we report our experience with the use of SNM with the Interstim ® device for the treatment of severe urinary voiding dysfunction in patients with post-traumatic brain injury, who failed conservative medical and behavioral therapy.
Methods: Patients with severe voiding dysfunction secondary to post-traumatic brain injury damage with an intact spinal cord and without anatomical anomalies underwent InterStim ® trial testing. All had failed all conservative medical and behavioral treatments. The trial was considered successful with = 50 % improvement of symptoms compared to baseline. Persistence of symptomatic benefit was monitored with periodic follow up.
Results: From November 2013 to November 2017, 16 patients (11 male and 5 female) were tested. Voiding dysfunctions included urgency/frequency (14pt.), urinary incontinence (13pt.), dissinergia (8pt.). Twelve of them also had fecal disorders. Eventually 15/16 patients had a positive test and received the definitive Interstim ® implant. With a median follow-up of 60 months (19-71 mo.), 11/15 (73%) patients reported a lasting successful response in their urinary symptoms. In these patients urinary frequency decreased from 16 to 6 episodes/day, mean voided volume increased from 158cc to 350cc, incontinence disappeared in 8/13 patients (60%) and urgency disappeared in 11/14 patients (78%). Of 12 patients with intestinal disorders, 9 showed a significant lasting improvement (75%). Of the 4 patients who presented a delayed failure, one failed after 5 years without a clear explanation; in the other 3, evaluation of symptoms become impossible due to progressive post-traumatic cognitive impairment.
Conclusions: SNM with Interstim ® in post-traumatic brain injury patients is an effective option for urinary and fecal dysfunction when other conservative therapies fail. Selection of patients is crucial for best results. Our findings support the hypothesis that interstim ® may have an effect on central micturition control centers. Source of
