Effect of Subarachnoid Block in Hyperreflexic Bladder / 대한비뇨기과학회지

Hyperreflexic bladder is a disease manifested in patients with spinal cord lesions above the sacral segment. The treatments for hyperreflexic bladder are medical therapy, interruption of innervation, argumentation cystoplasty, etc. We treated four hyperreflexic bladder patients with 12% a phenol injection into the subarachnoid space for sacral nerve block. Before treatment the average bladder capacity was about 100 ml, and there was one case of autonomic dysreflexia. After the subarachnoid block the average bladder capacity increased above 300 ml and maximal intravesical pressure decreased below 30cmH2O, autonomic dysreflexia disappeared in one patient. The decreased bladder compliance after nerve block was managed by repetitive bladder overdistention. We suggest that subarachnoid block is easier and more effective than sacral nerve block individually, and is a treatment for hyperreflexic bladder refractory to medical therapy.

Clinical Observation of the Effect of Sacral Block with Phenol in Hyperreflexic Bladder Patient / 대한비뇨기과학회지

Percutaneous chemical neurolysis of sacral nerve with phenol was performed on 11 cases of hyperreflexic bladder to augment bladder capacity and to make intermittent clean catheterization more feasible. Urodynamic evaluations were done before and after chemical neurolysis. Followup ranged from 10 months to 16 months(mean 13 months). Mean bladder capacity increased significantly after chemical neurolysis ( from 157.5ml to 340ml). No significant changes in bowel or injection sites were noted. Continence was improved in 100%, with 7 patients remaining completely dry and voiding with intermittent self-catheterization. The long term results were necessary but we considered the chemolysis of sacral nerve was available modality for hyperreflexic bladder patients, who did not respond to anticholinergic medication, before decide the more aggressive alternatives, such as augmentation cystoplasty or urinary diversion.