Use of the intradural stimulator is limited by its need highly specialized centers that can provide the necessary careful selection and evaluation of the patients; the complex electronic instrumentation and familiarity of specialized neurosurgeons and urologists with urodynamics, neurourology and the risk of serious permanent damage; and the availability of continued care to patients who do not live near such centers. Use of the intradural stimulator still must be considered experimental. Spinal neurostimulation of the bladder currently is best suited for spinally injured patients in whom intradural rhizotomy and afferent stimulation has been successful, with management of all three major pelvic functions. The results in patients treated by electrostimulation should be compared with those of patients treated by simpler, less expensive means. The safest effective neuroprosthesis is the TENS. Its use is fully reversible with no permanent sequelae to the patient. Present applications are limited to management of bladder instability and pelvic pain. Electrostimulation for bladder retraining, although an intriguing technique, would seem to be limited by the time involved and the potential costs. Treatment of voiding dysfunction and instability of the bladder by implantable electrodes in otherwise healthy patients appears to be a promising technique for the most experienced investigators.
|Original language||English (US)|
|Number of pages||12|
|Journal||Problems in Urology|
|State||Published - Jan 1 1993|
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