Clinical results of a brindley procedure: sacral anterior root stimulation in combination with a rhizotomy of the dorsal roots

F M J Martens, J P F A Heesakkers, F M J Martens, J P F A Heesakkers

Abstract

The Brindley procedure consists of a stimulator for sacral anterior-root stimulation and a rhizotomy of the dorsal sacral roots to abolish neurogenic detrusor overactivity. Stimulation of the sacral anterior roots enables micturition, defecation, and erections. This overview discusses the technique, selection of patients and clinical results of the Brindley procedure. The Brindley procedure is suitable for a selected group of patients with complete spinal cord injury and detrusor overactivity. Overall, the Brindley procedure shows good clinical results and improves quality of life. However, to remain a valuable treatment option for the future, the technique needs some adequate changes to enable analysis of the implanted parts, to improve revision techniques of the implanted parts, and to abolish the sacral dorsal rhizotomy.

Figures

Figure 1
Figure 1
Example of poststimulus voiding using a Brindley stimulator. The three upper traces show the intravesical (Pves), intra-abdominal (Pabd), and detrusor (Pdet) pressures during stimulation with a Brindley stimulator. The increase in EMG signal reflects the activation of the stimulus during 5 seconds. Stimulation is activated every 12 seconds. The intermittent stimulation pattern allows the urethral sphincter to relax while the detrusor pressure remains elevated. This results in an intermittent flow pattern.
Figure 2
Figure 2
Results of the Brindley procedure on micturition, continence, defecation, and erections are summarised.

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