Review of sacral electrical stimulation in the management of the neurogenic bladder

In patients with spinal cord injury above the conus medullaris, electrical stimulation of the sacral anterior nerve roots can produce micturition with low residual volumes of urine and reduced urinary tract infection. Vowing pressures appear to be maintained at safe levels by the use of an intermittent pattern of stimulation. The procedure is usually combined with division of the sacral posterior roots, which increases bladder capacity and continence; this also increases bladder compliance, which may be protective for the upper urinary tracts.The procedure has now been applied in about 900 patients with spinal cord injury, some of whom have been followed up for over 15 years. The nerves do not appear to be damaged by long-term stimulation and technical faults with the equipment are now uncommon.