Abnormal oculovestibular response.

In normal individuals, the visual and vestibular systems interact through a common subcortical center located near the vestibular nuclei. When the patient is healthy, this interaction allows appropriate integration of what might otherwise be conflicting information regarding environmental motion and moving within the environment. In patients with active peripheral vestibular lesions, such as those seen in Meniere's disease, this delicate interaction loses effectiveness. In such patients, optokinetic stimuli are capable of precipitating episodes of incapacitating vertigo with its associated vegetative symptoms (abnormal oculovestibular response--AOVR). Since the brainstem is unable to accommodate for active peripheral lesions, suffering may be prolonged for many years. Vestibular nerve section, however, converts this active lesion to a static peripheral lesion, allowing for brainstem compensation and cessation of optokinetic-induced vertiginous symptoms.

Selective sacral rootlet neurectomy in the treatment of detrusor hyperreflexia. Technique and long-term results.

Selective sacral neurectomy was performed in 12 patients with intractable urge incontinence of long duration (mean 12 years) caused by detrusor hyperreflexia. There was great variation in the innervation of the bladder, but resection of an S-3 root or rootlet was carried out in all patients. Six of the patients, who were followed for a mean period of 5.8 years, were cured, and symptoms recurred in two patients after 1 1/2 and 2 years. In patients whose detrusor hyperreflexia recurred, the amplitude of the bladder contractions was significantly lower. This treatment appears reasonable in patients with severe intractable voiding dysfunction caused by detrusor hyperreflexia.

Percutaneous sacral rhizotomy for neurogenic detrusor hyperreflexia.

Ten patients with neurogenic detrusor hyperreflexia were treated by percutaneous radiofrequency sacral rhizotomy. All had low-threshold involuntary micturition. The bladder capacity of seven patients was increased to over 290 cc during a follow-up interval of 3 to 18 months. This convenient percutaneous procedure is particularly suited for controlling detrusor hyperreflexia, which has frequent failures of initial treatment and late recurrence of symptoms.

Percutaneous radiofrequency sacral rhizotomy in the treatment of the hyperreflexic bladder.

Percutaneous radiofrequency rhizotomy was performed on 7 patients with a hyperreflexic bladder to augment bladder capacity and to make intermittent clean catheterization more feasible or stop precipitous micturition. Urodynamic evaluations were done before and after rhizotomy. A successful result was achieved in 6 patients. Patient selection and methodology are discussed and some of the previously reported series of rhizotomies are compared to the present study.

Detrusor hyperreflexia in benign infravesical obstruction. a cystometic study.

Cystometry was performed on 94 consecutive patients with benign prostatic hypertrophy or bladder neck obstruction, 45 per cent of whom had detrusor hyperreflexia. Of those cases with detrusor hyperreflexia 21 patients were re-examined 6 months postoperatively and 62 per cent of them had regained normal bladder function. The underlying pathophysiologyand the clinical aspects are discussed.