Radiofrequency Sacral Rhizotomy for the Management of Intolerable Neurogenic Bladder in Spinal Cord Injured Patients

OBJECTIVE: To investigate the effect of radiofrequency (RF) sacral rhizotomy of the intolerable neurogenic bladder in spinal cord injured patients. METHOD: Percutaneous RF sacral rhizotomy was performed on 12 spinal cord injured patients who had neurogenic bladder manifested with urinary incontinence resisted to an oral and intravesical anticholinergic instillation treatment. Various combinations of S2, S3, and S4 RF rhizotomies were performed. The urodynamic study (UDS) was performed 1 week before RF rhizotomy. The voiding cystourethrogram (VCUG) and voiding diaries were compared 1 week before and 4 weeks after therapy. Total volume of daily urinary incontinence (ml/day) and clean intermittent catheterization (ml/time) volume of each time were also monitored. RESULTS: After RF sacral rhizotomy, bladder capacity increased in 9 patients and the amount of daily urinary incontinence decreased in 11 patients. The mean maximal bladder capacity increased from 292.5 to 383.3 ml (p<0.05) and mean daily incontinent volume decreased from 255 to 65 ml (p<0.05). Bladder trabeculation and vesicoureteral reflux findings did not change 4 weeks after therapy. CONCLUSION: This study revealed that RF sacral rhizotomy was an effective method for neurogenic bladder with uncontrolled incontinence using conventional therapy among spinal cord injured patients.

Experience with Sacral Rhizotomy for Perineal and Perianal Cancer Pain

Since 1980, 18 patients(12 males, 6 females) with intractable perineal and perianal pain caused by uncontrolled malignant neoplastic disease, were surgically treated with sacral rhizotomy. Patients ranged in age from 33 to 74 years ; the duration of symptoms ranged from 2 months to 17 months. The primary site of the malignancies were as follows : prostate cancer(3 cases), cervix cancer(5), colorectal cancer(10). All patients underwent preoperative psychological test, drug assessment, cystometry and trial block. The present criteria for selection were : 1) All patients should have uncontrolled malignant disease with metastasis. 2) The pain should be limited to the perineal or the perianal region. 3) The pain should be severe and refractory to medical and psychological management. 4) The pain should be of least 3 months. 5) Estimated life expectancy should be at least 3 months. 6) All patients should have had a previous colostomy. 7) The operative modification should be made according to the urinary disturbance. If there is no voluntary urination, the operation should include both S2 roots ; but, if the bladder is still functioning normally, the S2 root should be preserved in the least painful side. Postoperative results of pain control were no pain in 14 patients(78%), good in three(16%), and poor in one(6%). After reviewing the results, the authors believe that if the patients are selected properly, according to the criteria outlined, sacral rhizotomy is worthwhile, simple and relatively successful method of treating intractable perineal and perianal cancer pain.