Sacral deafferentation with implantation of an anterior root stimulator. Experience after 15 years in 430 patients

565 SACRAL DEAFFERENTATION ANTERIOR ROOT STIMULATOR. IN 430 PATIENTS Sauerwein

WITH IMPLANTATION EXPERIENCE AFTER

OF AN 15 YEARS

URODYNAMIC

DATA

Vandoninck V.‘, Van’,

Fmazzi Agri, E.:‘, Heesakkers J.P.F.A.‘, Debruyne F.‘. Dcbnlyne F.M.J.‘, Kiemeney L.A.L.M.‘, Bemelmans B.L.H.’

D.S.

Werner-Wicker-Klinik,

566 POSTERIOR TIBIAL NERVE STIMULATION IN THE TREATMENT OF OVERACTIVE BLADDER AND VOIDING DYSFUNCTION:

Neuro-Urology,

Bad Wildungen,

Germany

INTRODUCTION & OBJECTIVES: Following the inauguration of sacral deafferentation in 1986 the method was shown to be able to re-establish bladder reservoir function in para and tetraplegic patients after supraconal spinal cord injury In addition, the simultaneous implantation of an anterior root stimulator (G. S. Brindley) made a controlled micturition possible. MATERIAL & METHODS: During the period of 1986 to 200 1 we treated 427 patients with supraconal lesions, two thirds of which were female. Their age ranged from I4 to 65 with an average of 34 years. The mean follow-up time is 6.2 years. Intraoperative monitoring of stimulation response allowed the identification of the anterior and posterior roots. In order to recognize the anterior roots the intravesical pressure response was registered upon stimulation. The Intradural Way means one operation and two steps. RESULTS: Stimulation of the anterior roots mostly S3 and S4 are able to achieve bladder emptying. Deafferentation stopped bladder spasticity in 97 percent of all cases. Kidney function recovered in response to the reconstituted reservoir function of the bladder. The rate of UT1 per year dropped from 6.4 preoperatively to 1.2 postoperatively 98 percent of the patients actually use the anterior root stimulator for micturition, which on the average is performed 4 times daily. Complete bladder emptying without or with low residual urine (150 ml) is achieved. The anterior root stimulator is also used in 95 percent for defecation 4.7 times per week in a shortened time. CONCLUSIONS: With the classic intradural way of this procedure, one operation two steps, SDAF is able to restore the reservoir function of the bladder with continence. With SARS, low-resistance micturition at a normal frequency is possible. Patients become independent of condom urinals and urinary pads drugs and CIC reducing patient management cost. Better quality of life, lower morbidity and greater life expectancy lead to a high acceptance of this mode of treatment in the paralysed patients.

567 DO PATIENTS WITH BLADDER PROFIT FROM SURGERY? beera G-M.‘, Stenzl A.‘, Ninkovic Bartsch G.‘, Strasser H.’

ACONTRACTILITY

REALLY

‘University Medical Center Nijmegen, Urology, Nljmegen, The Netherlands, Wmversity “Tar Vergata”, Urology, Rome, Italy. ‘University MedIcal Center Nijmegen, Epidemiology, Nijmegen, The Netherlands INTRODUCTION & OBJECTIVES: The aim of this study was to evaluate urodynamic changes after percutaneous tibia1 nerve stimulation (PTNS) for the treatment of complaints related to the overactive bladder syndrome OAB or voiding dysfunction and to search for urodynamic based predictive factors. MATERIALS & METHODS: 90 ~on~rc~twz patients with symptoms related to the overactwe bladder syndrome and 39 patients with chronic voiding dysfunction were enrolled in this study. Patients underwent 12 PTNS sessions. For evaluating objective success, the primary outcome measure was a reduction in number of urinary leakage episodes of SO% or more per 24hours or 50% reduction in total catheterised volume per 24 h. Patients’ request for contmuation of therapy was considered subjective SUCCESS.This study focused on urodynamic features at baseline and on changes found after 12 PTNS treatments. Odds ratios and their 95% contidence interval were computed as a measure for predictive power in order to reveal predictive factors. RESULTS: The objective success rate for OAB was 56% (leakages/24h), Its subjective success rate was 64%. Frequency/Volume chart data and quality of life scores improved signtficantly (p
CONCLUSIONS:

PTNS

dysfunction

were more prone to notice

could not abolish IX

PTNS

SUCCESS(Odds

increased cystometric

ratio:

capacity

and

delayed the onset of DI Cystometry scemed useful to select good candidates: patientc without Dl or with late DI onset showed to be the best candidates for PTNS. It might be an attractive first line option for patients with (mmor) voiding dysfunction.

P31 UPPERuRlt&RYTRACT: OBSTRUCTION, STRlCTlJRES ANDTCC Friday,March 13,15.30-17.00 hrs, RoomN107 ACUCISE

ENDOPYELOTOMY

IlINE THERAPY

AND

FOR SECONDARY

566

ENDOURETROTOMY:

URETERAL

FIRST

STRICTURES

M.‘, Prossec R.‘, Kinzl J., Rehder P.‘.

‘University of Innsbruck, Urology, Innsbruck, Austria, ‘University of Innsbruck. Psychiatry, Innsbruck, Austria, ‘University of Innsbruck. Surgery, Innsbruck. Austria INTRODUCTION & OBJECTIVES: As shown previously, reconstruction of the lower urinary tract using an innervated latissimus dorsi muscle (LDDM) free flap represents a feasible and effective option in treatment of bladder acontractility. The aim of this study was to evaluate the quality of life (QoL) after this invasive surgical treatment. MATERIAL & METHODS: Between 9/95 and 12100 21 patients (14 males 67%, 7 females, mean age: 39.5 years in males and 41.1 y in females) with bladder acontactility underwent transfer of an innervated autologous latissimus dorsi muscle as previously published by Stenzl et al (Lancet, 1998 May). Three validated questionnaires with regard to QoL were distributed before as well as after operation (to mean follow up 42 months): the FLZ questionnaire (to compare the patients with a representative standard population), the Symptom Check List (SLC-90R, to investigate the psychological and physical complaints) and the FACT-G (Functional Assessment of Cancer Therapy, to allow for self estimation of QoL). RESULTS: 1. FLZ: the average scores for*all but 2 individuals increased and showed an improvement of individual QoL life postoperatively. Mean FLZ-sum increased from 452.07 to 497.85 (D: 0.40). 2. SLC-90: Evaluation showed a reduction of all average complain;; scores. The decreased t-scores below the 60’s mark indicated, that the patients did not suffer from particular psychological stress. 3. FACT-G: Evaluation of this questionnaire showed the improvement of QoL. All four scales demonstrated higher values postoperatively. The average value of the subscale “Emotional condition” rose from- 17.27 preoperatively to 19.61 postoperatively and from 16.95 preop. to 19.37 postop. for the “functional condition”. Wilcoxon-test p-value 0.05.

tassi-Fehri

Ii.‘. Lelrek M.‘. Bade1 L.‘, Cherasse A.‘. Colombel

M.‘. Martin X.‘.

Gelet A.’ ‘Hcrriot

Unik. IIospital.

Urology

& Transplantation,

Lyon, France,

‘Meknes

Hospital, Urology, Mckncs, Marocco INTRODUCTION determine

& OBJECTIVES:

the long-term

efficacy

The purpose

of the acucise

ureteropelvic

junction

obstruction

ureterovesical

junction

strictures

(UPJO), (UVS)

of this study

balloon

was to

for the treatment

urcteral

strictures

and ureterocnteric

of

(US)

,

anastomosis

strictures (UEAS). MATERIAL

81 METHODS:

From .luly 1992 through

patients were treated by Acucise:

January

2002,

100

80 with IJPJO, 2 with mid US. 4 with distal

US. 7 with UVJS and 7 \vith UEAS. RESULTS: occurred

Mean opcrativc

time was 4X min (range 20-1801. Complications

in I9 % of cases but only IO major complications

Mean hospitalisation

were noted (10%).

stay was 4.8 days (range: I-19). Mean follow up was 29.8

months (range 3-85). The overall success rate was 79%. Good results, which ucrc defined by resolution urography

of symptoms

and improvement

of the intravenous

or diuretic renal scan, were observed in 52% of cases. In patients with

UPJO the success rate was 80%. but only 66.6% for primary for stage III/IV hydronephrosis.

UPJdand

In patients with ureteral strictures

59.3%

the success

rate was 83.3%. Success rate in UVS was 83.3% and in UEAS was 50%. Median time to failure was 4.2 months (range l-10).

CONCLUSIONS: Reconstruction of the lower urinary tract using LDDM free flap represents a feasible option in the treatment of acontractile bladders. Evaluation of the QoL showed long term satisfactory results for our patients. No patient reported poorer QoL postoperatively according to this evaluation. European

Urology

Supplements

2 (2003) No. 1, pp. 144

CONCLUSIONS:

secondary

We recommend

the use of Acucise as first line therapy for all

urcteral strictures wherever their location in the ureter.