Acta Neurochirurgica

, Volume 160, Issue 7, pp 1377–1384 | Cite as

Effect of spinal anterior root stimulation and sacral deafferentation on bladder and sexual dysfunction in spinal cord injury

  • Hamed Zaer
  • Mikkel Mylius Rasmussen
  • Franko Zepke
  • Charlotte Bodin
  • Burkhard Domurath
  • Johannes Kutzenberger
Original Article - Spine - Other



Spinal cord injury (SCI) is a highly devastating injury with a variety of complications; among them are neurogenic bladder, bowel, and sexual dysfunction. We aimed to evaluate the effect of sacral anterior root stimulation with sacral deafferentation (SARS-SDAF) on neurogenic bladder and sexual dysfunction in a large well-defined spinal cord injury cohort.


In the manner of cross-sectional study, subjects undergone SARS-SDAF between September 1986 and July 2011 answered a questionnaire concerning conditions before and after surgery in the department of Neuro-Urology, Bad Wildungen, Germany.


In total 287 of 587 subjects were analyzed. Median age was 49 years (range 19–80), median time from SCI to surgery was 10 years (range 0–49), and from surgery to follow-up 13 years (range 1–25). Of the analyzed subjects, 100% of both gender used SARS for bladder emptying. On the visual analogue scale (VAS) ranging from 0 to 10 (best), satisfaction with SARS-SDAF was 10 concerning bladder emptying, however 5 and 8 regarding sexual performance, for female and male users, respectively. Baseline and follow-up comparison showed a decline in self-intermittent catheterization (p < 0.0001), partial catheterization by attendant (p = 0.0125), complete catheterization and suprapubic catheterization (p < 0.0001), transurethral catheterization (p < 0.0011), and fewer cases of involuntary urine leakage (p < 0.0001).


The SARS-SDAF is a beneficial multi-potential treatment method with simultaneous positive effect on multi-organ dysfunction among SCI subjects.


Spinal cord injury Spinal anterior root stimulation Neurogenic bladder Bladder rehabilitation Spinal deafferentation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.


  1. 1.
    Alexander MS, Biering-Sorensen F, Elliott S, Kreuter M, Sonksen J (2011) International spinal cord injury female sexual and reproductive function basic data set. Spinal Cord 49:787–790. CrossRefPubMedGoogle Scholar
  2. 2.
    Basson R (2000) The female sexual response: a different model. J Sex Marital Ther 26:51–65. CrossRefPubMedGoogle Scholar
  3. 3.
    Biering-Sorensen F, Craggs M, Kennelly M, Schick E, Wyndaele JJ (2008) International lower urinary tract function basic spinal cord injury data set. Spinal Cord 46:325–330. CrossRefPubMedGoogle Scholar
  4. 4.
    Brindley GS (1993) History of the sacral anterior root stimulator, 1969-1982. Neurourol Urodyn 12:481–483CrossRefPubMedGoogle Scholar
  5. 5.
    Brose SW, Bourbeau DJ, Gustafson KJ (2017) Genital nerve stimulation is tolerable and effective for bladder inhibition in sensate individuals with incomplete SCI. J Spinal Cord Med 1–8.
  6. 6.
    Cardoso FL, Savall AC, Mendes AK (2009) Self-awareness of the male sexual response after spinal cord injury. Int J Rehabil Res 32:294–300. CrossRefPubMedGoogle Scholar
  7. 7.
    Chen D, Apple DF Jr, Hudson LM, Bode R (1999) Medical complications during acute rehabilitation following spinal cord injury—current experience of the model systems. Arch Phys Med Rehabil 80:1397–1401CrossRefPubMedGoogle Scholar
  8. 8.
    Emmons RR, Garber CE, Cirnigliaro CM, Kirshblum SC, Spungen AM, Bauman WA (2011) Assessment of measures for abdominal adiposity in persons with spinal cord injury. Ultrasound Med Biol 37:734–741. CrossRefPubMedGoogle Scholar
  9. 9.
    Fisher TL, Laud PW, Byfield MG, Brown TT, Hayat MJ, Fiedler IG (2002) Sexual health after spinal cord injury: a longitudinal study. Arch Phys Med Rehabil 83:1043–1051. CrossRefPubMedGoogle Scholar
  10. 10.
    Huang Q, Oya H, Flouty OE, Reddy CG, Howard MA 3rd, Gillies GT, Utz M (2014) Comparison of spinal cord stimulation profiles from intra- and extradural electrode arrangements by finite element modelling. Med Biol Eng Comput 52:531–538. CrossRefPubMedGoogle Scholar
  11. 11.
    Krasmik D, Krebs J, van Ophoven A, Pannek J (2014) Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury. Neurourol Urodyn 33:1202–1206. CrossRefPubMedGoogle Scholar
  12. 12.
    Kreuter M, Taft C, Siosteen A, Biering-Sorensen F (2011) Women’s sexual functioning and sex life after spinal cord injury. Spinal Cord 49:154–160. CrossRefPubMedGoogle Scholar
  13. 13.
    Kutzenberger J (2007) Surgical therapy of neurogenic detrusor overactivity (hyperreflexia) in paraplegic patients by sacral deafferentation and implant driven micturition by sacral anterior root stimulation: methods, indications, results, complications, and future prospects. Acta Neurochir Suppl 97:333–339PubMedGoogle Scholar
  14. 14.
    Levi R, Ertzgaard P (1998) Quality indicators in spinal cord injury care: a Swedish collaborative project. The Swedish Spinal Cord Injury Council 1998. Scand J Rehabil Med Suppl 38:1–80PubMedGoogle Scholar
  15. 15.
    Rasmussen MM, Kutzenberger J, Krogh K, Zepke F, Bodin C, Domurath B, Christensen P (2015) Sacral anterior root stimulation improves bowel function in subjects with spinal cord injury. Spinal Cord 53:297–301. CrossRefPubMedGoogle Scholar
  16. 16.
    Sauerwein D (1990) Surgical treatment of spastic bladder paralysis in paraplegic patients. Sacral deafferentation with implantation of a sacral anterior root stimulator. Urologe A 29:196–203PubMedGoogle Scholar
  17. 17.
    Seif C, Junemann KP, Braun PM (2004) Deafferentation of the urinary bladder and implantation of a sacral anterior root stimulator (SARS) for treatment of the neurogenic bladder in paraplegic patients. Biomed Tech (Berl) 49:88–92. CrossRefGoogle Scholar
  18. 18.
    Vastenholt JM, Snoek GJ, Buschman HP, van der Aa HE, Alleman ER, Ijzerman MJ (2003) A 7-year follow-up of sacral anterior root stimulation for bladder control in patients with a spinal cord injury: quality of life and users’ experiences. Spinal Cord 41:397–402. CrossRefPubMedGoogle Scholar
  19. 19.
    Wyndaele JJ (2016) The management of neurogenic lower urinary tract dysfunction after spinal cord injury. Nat Rev Urol 13:705–714. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, CENSEAarhus UniversityAarhusDenmark
  2. 2.Department of Neurosurgery, CENSE-spineAarhus University HospitalAarhusDenmark
  3. 3.Department of Neuro-Urology, Werner-Wicker-KlinikBad Wildungen-ReinhardhausenGermany

Personalised recommendations