Selective sacral nerve blockade for the treatment of unstable bladders

38 patients with severe urge or urge incontinence, who did not respond to conservative therapy, were treated with selective sacral nerve blockade using a local anesthetic (bupivacaine). 6 patients of this group had definite selective sacral denervation with phenol. In 31 patients a urodynamic study was done previous to the sacral nerve block as well as 10 and 90 min after the injection. Within the first 2-7 weeks the success rate was about 70% in regard to bladder capacity and mean volume at first desire to void. On long-term follow-up (greater than 7 months), the success rate decreased to about 16%. Only 1 patient of the phenol group still has complete detrusor areflexia for now more than 2 years. 4 male patients with advanced or locally recurrent bladder tumors had the sacral block because of severe perineal or suprapubic pain. Subjectively their response seemed to be better. According to our experience nonoperative central bladder denervation with selective sacral nerve blockade using local anesthetics or phenol shows no convincing results on long-term follow-up. Since it is a minimal invasive technique, which can be repeated several times, it may be helpful for some patients and offers a chance to bypass major surgical denervation procedures.