Selective sacral cryoneurolysis in the treatment of patients with detrusor instability/hyperreflexia and hypersensitive bladder

Abstract

AbstractUsing selective sacral cryoneurolysis, we treated 28 patients with detrusor instability (DI), hypersensitive bladder (HSB), or detrusor hyperreflexia (DH). A cystometrogram (CMG) was done before and after percutaneous, transsacral infiltration of a sacral nerve root with bupivacaine until a dominant root was identified as judged by a 50% or greater increase in the maximum cystometric capacity (MCC), and/or a 50% or greater decrease in the peak intravesical pressure at the time of the first unstable contraction (P1). The volume at first desire to void (VDV) was also noted. The dominant root was then blocked with a cryoprobe.In the non‐neurologic group (20), the mean MCC was increased by 61% and the mean P1 decreased by 21%. The VDV was increased significantly. Clinically, 16 out of 17 patients had good or excellent results and one had poor results when followed from 1 to 10 months. The mean duration of effect was 4.8 months. Eleven patients had repeat neurolysis, usually with comparable results. In the neurological patients (8) there was a 165% increase in mean MCC and a 40% fall in P1. In six patients followed up for 1.5–10 months the results were good or excellent in five and poor in one with a mean duration of effect of 3.6 months. Transient sensory side effects were common in the non‐neurological patients, and this combined with the need for repeat treatments may have affected patient compliance.It is concluded that selective sacral cryoneurolysis has a useful role in the management of the patient with DI/DH or HSB who has failed to respond to pharmacotherapy.