Pelvic organ dysfunction rehabilitation

Spinal cord injury patients can suffer urinary complications. PD. Dr. Med. André Reitz and Prof. Dr. Med. Regula Doggweiler explain how to treat them in this exclusive interview.

How frequent are pelvic organ dysfunctions in neurological diseases?

It depends on the type of neurological disease or level of lesion, but in the past, renal failure was the leading cause of death after spinal cord injury (SCI).

Today mortality from SCI has declined dramatically partly owing to the improved management of urologic dysfunction associated with SCI.

The goals of bladder management in spinal cord injury patients are intended to ensure social continence for reintegration into community, allow low-pressure storage and efficient bladder emptying at low detrusor pressures, avoid stretch injury from repeated overdistension, prevent upper and lower urinary tracts complications from high intravesical pressures, and prevent recurrent urinary tract infections.

How can pelvic rehabilitation improve the quality of life of a wheelchair user?

Pelvic organ dysfunction can affect anybody – young and old, women and men. Thanks to enormous progress, embracing discoveries and new technologies, today effective treatments of bladder, bowel and sexual dysfunctions are possible.

Complications can be avoided and quality of life can be reestablished. Furthermore, pelvic organ dysfunction is a chronic neurogenic disease that can vary considerably, even within a relatively short period of time.

Regular follow-up, early intervention and adequate treatment can prevent irreversible deterioration of both the lower and upper urinary tracts. Follow-up intervals depend on the individual-risk and complication profiles; in general, a follow-up is recommended every one or two years.

How does sacral neuromodulation in pelvic floor disorders work?

Sacral nerve neuromodulation (sacral nerve stimulation with the Interstim system) is an effective and efficacious tool for management of medically refractory urinary or fecal incontinence or retention/constipation and offers a less morbid surgical approach to these problems in selected patients.

Could you explain the bladder pacemaker procedure?

This is a two stage procedure. The first stage is done under local anesthesia and introduction of 2 – 4 test leads. Other times the first stage is done in the operating room under local or under general anesthesia.

A small incision will also be made in the lower back where a long-term electrode will be inserted next to the sacral nerves. The external neurostimulator sends the electrical pulses through this thin wire to the sacral nerves.

The second stage is done if the symptoms (incontinence, urgency and frequency or retention) improved at least 50%. This will be the implantation oft he whole system (if temporary leads were placed) or implant just of the battery if the long-term electrode was already placed. A small incision will be made in the upper buttock where the neurostimulator will be placed under the skin.

After the surgery, the physician will program the neurostimulator to give the same stimulation as during the evaluation. The patient will be shown how to use the patient programmer to adjust the settings.

Can a bladder Pacemaker cause side effects?

As in any operation there can be complications such as bleeding or infection, but they seldom happen. However, if an infection occurs the whole system needs to be explanted.

There can be pain at the site of the battery or the lead. Patients with this device can only undergo low dose MRI. If they have to undergo an other surgery the system has to be switched off during the procedure.

For more information, see the pelvic rehabilitation program brochure or visit Kontinenzzentrum

André Reitz, M.D.
Specialist for Urology
Assistant Professor of Neurourology
Fellow of the European Board of Urology

Regula Doggweiler, M.D.
Specialist for Urology
Professor of Neurourology

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