Hohenfellner M, Paick J S, Trigo-Rocha F, Schmidt R A, Kaula N F, Thüroff J W, Tanagho E A
Department of Urology, University of California School of Medicine, San Francisco 94143.
J Urol. 1992 Jun;147(6):1665-70. doi: 10.1016/s0022-5347(17)37674-7.
Based on the clinical experience of treating neurogenic bladders by the electrical stimulation of the ventral sacral roots, neuroanatomical and neurophysiologic studies were designed to study the mechanism of detrusor-sphincter dyssynergia during electrical stimulation of the sacral roots. An experimental model was developed to decrease the stimulation response of the pelvic floor and external urethral sphincter muscles while preserving bladder contraction. The significance of the site of deafferentation and electrode implantation was evaluated under functional and clinical aspects. Our results indicate that a combination of intradural deafferentation and extradural electrode implantation may offer maximal deafferentation efficiency with minimal surgical risk. Intradural deafferentation is facilitated by a consistent arrangement of sacral roots with the dorsal roots running laterally to the ventral roots at the site of their exit from the dura. Detrusor-sphincter dyssynergia can be reduced by selective division of ventral sacral rootlets innervating the striated musculature of the pelvic floor and the urethral sphincter.
基于通过电刺激骶前根治疗神经源性膀胱的临床经验，设计了神经解剖学和神经生理学研究，以探讨骶根电刺激期间逼尿肌-括约肌协同失调的机制。建立了一个实验模型，以降低盆底和尿道外括约肌的刺激反应，同时保留膀胱收缩功能。从功能和临床方面评估了去传入神经部位和电极植入部位的意义。我们的结果表明，硬膜内去传入神经和硬膜外电极植入相结合可提供最大的去传入神经效率，同时手术风险最小。骶根在从硬脊膜穿出部位的一致排列有利于硬膜内去传入神经，即背根在腹根外侧走行。通过选择性切断支配盆底横纹肌和尿道括约肌的骶前根小支，可以减少逼尿肌-括约肌协同失调。
