The Hindu : Karnataka News : Rare procedure performed to rectify bladder dysfunction

Online edition of India's National Newspaper
Sunday, Jun 06, 2004

Karnataka

Karnataka

Rare procedure performed to rectify bladder dysfunction

By Our Special Correspondent

BANGALORE, JUNE 5. Neurosurgeons at Manipal Hospital's Institute of Neurological Disorders have successfully treated a 17-year-old boy with neurogenic bladder dysfunction.

The procedure, "sacral nerve stimulation", is rare, according to N.K. Venkatramana, who carried it out on Sukumar from Tamil Nadu. He faced difficulty in passing urine and had no control over his bladder. This meant he needed repeated catheterisation to empty his bladder.

He was unable to mix freely with friends and family and found it difficult to attend classes or social functions.

Dr. Venkatramana said several urologists had examined Sukumar and he underwent sphincter correction surgery to facilitate normal urination. But it did not help him.

"Two primary functions of the lower urinary tract are the storage and timely passing of urine. This is normally done by a synchronised action of the urinary bladder and urethra with its sphincters. These functions are controlled by neural circuits located in the brain and spinal cord. Any dysfunction due to disturbance in these neurological circuits is termed neurogenic bladder dysfunction,'' he added.

Sukumar's MRI scan did not reveal any structural abnormality of the spinal cord. He was given trial stimulation with an electrode. This improved his bladder function significantly and the doctors decided on the permanent implantation of the electrode and stimulation device.

"After the implantation, he is able to pass urine without the need for catheterisation and his social behaviour has improved. He now wants to study in a boarding school,'' Dr. Venkataramana said.

The disorder Sukumar had can occur in neurological diseases affecting the brain and spinal cord and sacral nerves. Examples of such diseases are spina bifida, tethered cord syndrome and spinal cord injury and tumours. Sacral nerve stimulation is considered ideal for select patients. This was first introduced in 1990 and has gone through several modifications. Now the system is called "interstim therapy" and comprises a battery-powered generator connected to a quadripolar electrode through a cable. The voltage can be adjusted and it induces constant electrical stimulation helping the patient urinate normally.

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