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The System The Bladder System in an implantable device that restores bladder and bowel control to people with spinal cord injury. Implants of this type have been used in centres in Europe since 1978. The Bladder System stimulates the sacral anterior roots to achieve bladder and bowel emptying. Two different surgical approaches can be used to connect the electrodes to the nerve roots for stimulation: A) intrathecal or B) extradural connection. The choice between these two approaches depends on the surgical and medical indications. The Bladder System is supplied as a kit for either extradural or intrathecal implantation. Intrathecal Electrodes Intrathecal electrodes are implanted at the level of the cauda equina in contact with the sacral anterior nerve roots, usually S2-4. Surgical access is provided by a lower lumber laminectomy. Cables from the electrodes pass through a grommet implanted in the dura mater and are passed subcutaneously to the implanted receiver-stimulator on the front of the body. Intrathecal implantation of electrodes is usually combined with rhizotomy of the posterior sacral nerve roots in the cauda equina. Extradural Electrodes
How the system works (Refer to extradural graphic) 1 The Bladder System features a Digital External Control Unit (CPC1). This unit includes a digital display and a microprocessor which transmits a signal to the External Transmitter. 2 Command signals and power are sent to the External Transmitter which is held against the skin. 3 The External Transmitter sends the signal across the skin of the abdomen to a pacemaker-like Implantable Receiver-Stimulator. 4 The system sends electrical signals through Electrodes to the spinal nerves that lead to the bladder and bowel. These signals cause the muscles of the bladder and urethral sphincter to contract. While the bladder contracts in response to the electrical stimulus the sphincter muscles relax, allowing the bladder to empty. General benefits reported in published literature
These reports also indicate that the bladder stimulator has decreased the incidence of urinary tract infections (UTIs) and reduced catheter use in many patients. In some men, the stimulator has also been used to produce penile erection. Patient selection criteria At this time, the system is being implanted in individuals who have a spinal cord injury and meet the following criteria:
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Extradural
electrodes are implanted in the spinal canal of the sacrum in contact
with the sacral nerves, usually S2-4. Surgical access is provided
by a laminectomy of the upper part of the sacrum.Cables from the
electrodes are passed subcutaneously to the implanted receiver-stimulator
on the front of the body. Extradural implantation of electrodes
is usually combined with intradural posterior sacralrhizotomy at
the conus medicullaris, via a second small laminectomy at the thoracolumbar
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