Effects of sacral dorsal rhizotomy on bladder function in patients with spastic cerebral palsy.

Abstract

A newly revised operation for controlling spasticity in cerebral palsy patients, selective dorsal rhizotomy (SDR), has the potential to affect bladder function. The goal of this multidisciplinary study is to investigate the potential change in bladder function by characterizing and comparing pre- and post-operative symptoms and bladder function, both qualitatively and quantitatively, in 34 pediatric patients over the age of three with spastic cerebral palsy as the indication for selective dorsal rhizotomy. Video urodynamics were performed in a subset of patients. Almost all patients with quadriplegia were incontinent (8/9) and none were significantly helped with bladder control. Almost half (5/11) of patients with diplegia who failed prior bladder control training were able to gain continence post-operatively. No patient experienced permanent damage to the function of their bladder. In conclusion, selective dorsal rhizotomy using the revised technique of Peacock [Peacock et al. (1987): Pediatr Neurosci 13:61-66.] appears to be safe for spastic cerebral palsy patients' bladder function. It can help decrease symptoms and improve bladder capacity and control in almost half of those symptomatic cerebral palsy patients with diplegia.