An Artificial Somatic-Central Nervous System-Autonomic Reflex Pathway for Controllable Micturition After Spinal Cord Injury: Preliminary Results in 15 Patients
2003; Lippincott Williams & Wilkins; Volume: 170; Issue: 4 Part 1 Linguagem: Inglês
10.1097/01.ju.0000080710.32964.d0
ISSN1527-3792
AutoresChuan-Guo Xiao, Maoxin Du, CHENGPU DAI, Bing Li, Victor W. Νitti, William C. de Groat,
Tópico(s)Spinal Dysraphism and Malformations
ResumoNo AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Oct 2003An Artificial Somatic-Central Nervous System-Autonomic Reflex Pathway for Controllable Micturition After Spinal Cord Injury: Preliminary Results in 15 Patients CHUAN-GUO XIAO, MAO-XIN DU, CHENGPU DAI, BING LI, VICTOR W. NITTI, and WILLIAM C. de GROAT CHUAN-GUO XIAOCHUAN-GUO XIAO , MAO-XIN DUMAO-XIN DU , CHENGPU DAICHENGPU DAI , BING LIBING LI , VICTOR W. NITTIVICTOR W. NITTI , and WILLIAM C. de GROATWILLIAM C. de GROAT View All Author Informationhttps://doi.org/10.1097/01.ju.0000080710.32964.d0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Neurogenic bladder dysfunction after spinal cord injury (SCI) is a major medical and social problem for which there is no definitive solution. After the successful establishment in animals of a skin-central nervous system-bladder reflex pathway for micturition we performed this procedure on 15 patients with SCI who had 3 years of followup. Materials and Methods: A total of 15 male volunteers with hyperreflexic neurogenic bladder and detrusor external sphincter dyssynergia (DESD) caused by complete suprasacral SCI underwent limited hemilaminectomy and ventral root (VR) micro anastomosis, usually between the L5 and S2/3 VRs. The L5 dorsal root was left intact as the trigger of micturition after axonal regeneration. Mean followup was 3 years. All patients underwent urodynamic evaluation before surgery and during followup. Results: Preoperative studies in patients with complete suprasacral SCI revealed hyperreflexic neurogenic bladders and DESD with some differences in storage function during infusion cystometrograms. Of the 15 patients 10 (67%) regained satisfactory bladder control within 12 to 18 months after VR micro anastomosis. Average residual urine decreased from 332 to 31 ml and urinary infection as well as overflow incontinence disappeared. Urodynamic studies revealed a change from detrusor hyperreflexia with DESD and high detrusor pressure to almost normal storage and synergic voiding without DESD. Impaired renal function returned to normal. Two patients (13%) who required a skin stimulator to evoke voiding following the VR anastomosis had partial recovery but more than 100 ml residual urine. One patient was lost to followup and 2 had failure. Conclusions: An artificial somatic-central nervous system-autonomic reflex arc can be established surgically to provide a novel method for controlling bladder function in patients with complete suprasacral SCI who have hyperreflexic bladder and DESD. 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Google Scholar From the Departments of Urology (C-GX, M-XD, BL), Orthopedics and Microsurgery (CD), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China, Department of Urology, New York University School of Medicine (C-GX, VWN), New York, New York, and Department of Pharmacology, University of Pittsburgh School of Medicine (WCD), Pittsburgh, Pennsylvania© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByWein A (2018) Re: Challenges for Restoration of Lower Urinary Tract Innervation in Patients with Spinal Cord Injury: A European Single-Center Retrospective Study with Long-Term Follow-upJournal of Urology, VOL. 197, NO. 5, (1316-1317), Online publication date: 1-May-2017.Tuite G, Homsy Y, Polsky E, Reilly M, Carey C, Winesett S, Rodriguez L, Storrs B, Gaskill S, Tetreault L, Martinez D and Amankwah E (2018) Urological Outcome of the Xiao Procedure in Children with Myelomeningocele and Lipomyelomeningocele Undergoing Spinal Cord DetetheringJournal of Urology, VOL. 196, NO. 6, (1735-1740), Online publication date: 1-Dec-2016.Gomez-Amaya S, Barbe M, Brown J, Lamarre N, Braverman A, Massicotte V and Ruggieri M (2018) Bladder Reinnervation Using a Primarily Motor Donor Nerve (Femoral Nerve Branches) is Functionally Superior to Using a Primarily Sensory Donor Nerve (Genitofemoral Nerve)Journal of Urology, VOL. 193, NO. 3, (1042-1051), Online publication date: 1-Mar-2015.Rasmussen M, Rawashdeh Y, Clemmensen D, Tankisi H, Fuglsang-Frederiksen A, Krogh K and Christensen P (2018) The Artificial Somato-Autonomic Reflex Arch Does Not Improve Lower Urinary Tract Function in Patients with Spinal Cord LesionsJournal of Urology, VOL. 193, NO. 2, (598-604), Online publication date: 1-Feb-2015.Peters K, Girdler B, Turzewski C, Trock G, Feber K, Nantau W, Bush B, Gonzalez J, Kass E, de Benito J and Diokno A (2018) Outcomes of Lumbar to Sacral Nerve Rerouting for Spina BifidaJournal of Urology, VOL. 184, NO. 2, (702-708), Online publication date: 1-Aug-2010.XIAO C, DU M, LI B, LIU Z, CHEN M, CHEN Z, CHENG P, XUE X, SHAPIRO E and LEPOR H (2018) AN ARTIFICIAL SOMATIC-AUTONOMIC REFLEX PATHWAY PROCEDURE FOR BLADDER CONTROL IN CHILDREN WITH SPINA BIFIDAJournal of Urology, VOL. 173, NO. 6, (2112-2116), Online publication date: 1-Jun-2005.Joseph D (2018) Bladder Rehabilitation in Children with Spina Bifida: State-of-the-"ART"Journal of Urology, VOL. 173, NO. 6, (1850-1851), Online publication date: 1-Jun-2005. Volume 170Issue 4 Part 1October 2003Page: 1237-1241 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.KeywordsLaminectomybladder, neurogenicspinal cord injuriesbladderurinationneurons, efferentMetricsAuthor Information CHUAN-GUO XIAO More articles by this author MAO-XIN DU More articles by this author CHENGPU DAI More articles by this author BING LI More articles by this author VICTOR W. NITTI Financial interest and/or other relationship with BioForm, Pharmacia and Swartz Pharma. More articles by this author WILLIAM C. de GROAT More articles by this author Expand All Advertisement PDF DownloadLoading ...
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