BRINDLEY: Medico-economical Impact of the Brindley Neurosurgical Technique in France
Study Details
Study Description
Brief Summary
Bladder dysfunction is a major problem in patients with complete spinal cord lesions. For patients presenting incontinence or risk for kidney, two major conventional alternatives are possible : conservative therapies (muscarinic receptor antagonists, vanilloids drugs and botulinum toxin in association with catheterization) and surgical techniques intervening in the nervous and urinary system.
Among these last alternatives, the Brindley technique (anterior sacral root stimulation with posterior rhizotomy) is the only technique allowing for the restauration of bladder function, continence, and micturition. The purpose of the study is to compare the Brindley technique with the first conventional approach in France from a medical and economical point of view.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Background : In paraplegic and tetraplegic patients with suprasacral lesion, bladder overactivity leads to incontinence and is frequently associated with detrusor-sphincter dyssynergia which is responsible for residual postvoiding (high infectious risk) and intravesical high pressure (risk for kidney). The Brindley technique allows to restore a voluntary voiding of the bladder and an effective continence. Electrodes are fixed to anterior sacral roots in order to obtain micturition. Posterior sacral root rhizotomy suppress detrusor and sphincter overactivity, improves continence and thus protects bladder and kidney (low pressure bladder filling). Currently in France, 100 new patients could benefit from this innovative technique among the 1000 patients with spinal cord injury
Objective :To compare the cost/effectiveness ratio of the Brindley technique approach to that of the reference group (muscarinic receptor antagonists + catheterization or reflex micturition)at one year, in patient with neurogenic bladder.
In this prospective, comparative, non-randomized, multicenter study, the eligible patients are included according to the following ratio : 2:1 (Brindley : Reference ). The complete suprasacral spinal cord injured patients with an overactive neurogenic bladder, incontinence and/or risk of kidney/bladder injury) are the population studied. The spinal cord injury must be clinically stable for at least 3 months.
primary outcome :Proportion of patients showing a complete voluntary (including electrostimulation) micturition after one year.
Secondary outcome : Bladder capacity (cystometry), costs, incidence of urinary infections, incontinence, autonomic hyperreflexia (AHR), defecation, quality of life, lower limbs spasticity.
Patient follow-up :Visits must be planned at 1, 3, 6, 9 and 12 months: A classical clinical exam and a specific exam (evaluation of AHR, Ashworth and Penn Score) at 6 and 12 months and the following complementary exams at 3, 6 and 12 months: urodynamic testing and intravenous urography, retrograde ureterocystography and bladder echography at 12 months.
Population size : A total number of 99 patients must be enrolled to achieve the fixed goals (66 patients in the Brindley group and 33 patients in the Reference group).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: 1 Brindley technique (bladder system) |
Device: Brindley technique (bladder system)
Sacral posterior rhizotomies and implantation of Brindley device on sacral anterior roots
|
| No Intervention: 2 Reference group |
Outcome Measures
Primary Outcome Measures
- Proportion of patients showing a complete voluntary (including electrostimulation) micturition [At 3 months, 6 months and at one year]
Secondary Outcome Measures
- Bladder capacity (cystometry) [At 3 months, 6 months and after one year]
- costs [At 3 months, 6 months, 9 months and at one year]
- incidence of urinary infections [At visit 3, 6 and at one year]
- incontinence [At 3 months, 6 months and at one year]
- autonomic hyperreflexia (AHR) [At 3 months, 6 months, and at one year]
- defecation [at 3 months, 6 months and at one year]
- quality of life [at 6 months and at one year]
- lower limbs spasticity [at 3 months, 6 months and at one year]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patient with a complete suprasacral spinal cord injury proved by a clinical exam (perineal reflex preserved) and MRI.
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Clinically stable spinal cord injury for at least 6 months (verified by MRI)
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Patient with an overactive neurogenic bladder (urodynamic testing), incontinence (specific patient diary) and/or risk for the bladder/kidney (intravenous urography, cystography)
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signed informed consent
Exclusion Criteria:
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Injured sacral medullar centers or injured sacral roots
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Non contractile bladder
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Pregnancy or breast feeding
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Contraindication linked to neurostimulator implantation: unwounded cutaneous lesion, prolonged septic state, blood coagulation deficiency, known allergy to one component of the implanted medical device (silicone, platinum, iridium)
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Incapacity to receive an informed consent, incapacity to follow all the study schedule,
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patient not protected by social security
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Neurochirurgie A - Hôpital Pellegrin , Place Amélie Raba-Léon | Bordeaux Cedex | France | 33076 |
Sponsors and Collaborators
- University Hospital, Bordeaux
- Ministry of Health, France
Investigators
- Principal Investigator: Jean-Rodolphe Vignes, Doctor, University Hospital, Bordeaux
- Study Chair: Geneviève Chêne, Professor, University Hospital, Bordeaux
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 9415-04
- 2004-001