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AN ARTIFICIAL SOMATIC-AUTONOMIC REFLEX PATHWAY PROCEDURE FOR BLADDER CONTROL IN CHILDREN WITH SPINA BIFIDA

2005; Lippincott Williams & Wilkins; Volume: 173; Issue: 6 Linguagem: Inglês

10.1097/01.ju.0000158072.31086.af

1527-3792

Chuan-Guo Xiao, MAO-XIN DU, Bing Li, Zhao Liu, Ming Chen, ZHAO-HUI CHEN, Ping Cheng, XiaoNan Xue, Ellen Shapiro, Herbert Lepor,

Urinary Bladder and Prostate Research

No AccessJournal of UrologyPediatric Urology1 Jun 2005AN ARTIFICIAL SOMATIC-AUTONOMIC REFLEX PATHWAY PROCEDURE FOR BLADDER CONTROL IN CHILDREN WITH SPINA BIFIDA CHUAN-GUO XIAO, MAO-XIN DU, BING LI, ZHAO LIU, MING CHEN, ZHAO-HUI CHEN, PING CHENG, XIAO-NAN XUE, ELLEN SHAPIRO, and HERBERT LEPOR CHUAN-GUO XIAOCHUAN-GUO XIAO More articles by this author , MAO-XIN DUMAO-XIN DU More articles by this author , BING LIBING LI More articles by this author , ZHAO LIUZHAO LIU More articles by this author , MING CHENMING CHEN More articles by this author , ZHAO-HUI CHENZHAO-HUI CHEN More articles by this author , PING CHENGPING CHENG More articles by this author , XIAO-NAN XUEXIAO-NAN XUE More articles by this author , ELLEN SHAPIROELLEN SHAPIRO More articles by this author , and HERBERT LEPORHERBERT LEPOR More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000158072.31086.afAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Neurogenic bladder is a major problem for children with spina bifida. Despite rigorous pharmacological and surgical treatment, incontinence, urinary tract infections and upper tract deterioration remain problematic. We have previously demonstrated the ability to establish surgically a skin-central nervous system-bladder reflex pathway in patients with spinal cord injury with restoration of bladder storage and emptying. We report our experience with this procedure in 20 children with spina bifida. Materials and Methods: All children with spina bifida and neurogenic bladder underwent limited laminectomy and a lumbar ventral root (VR) to S3 VR microanastomosis. The L5 dorsal root was left intact as the afferent branch of the somatic-autonomic reflex pathway after axonal regeneration. All patients underwent urodynamic evaluation before and after surgery. Results: Preoperative urodynamic studies revealed 2 types of bladder dysfunction— areflexic bladder (14 patients) and hyperreflexic bladder with detrusor external sphincter dyssynergia (6). All children were incontinent. Of the 20 patients 17 gained satisfactory bladder control and continence within 8 to 12 months after VR microanastomosis. Of the 14 patients with areflexic bladder 12 (86%) showed improvement. In these cases bladder capacity increased from 117.28 to 208.71 ml, and mean maximum detrusor pressure increased from 18.35 to 32.57 cm H2O. Five of the 6 patients with hyperreflexic bladder demonstrated improvement, with resolution of incontinence. Urodynamic studies in these cases revealed a change from detrusor hyperreflexia with detrusor external sphincter dyssynergia and high detrusor pressure to nearly normal storage and synergic voiding. In these cases mean bladder capacity increased from 94.33 to 177.83 ml, and post-void residual urine decreased from 70.17 to 23.67 ml. Overall, 3 patients failed to exhibit any improvement. Conclusions: The artificial somatic-autonomic reflex arc procedure is an effective and safe treatment to restore bladder continence and reverse bladder dysfunction for patients with spina bifida. References 1 : The clinical diagnosis of disorders of the spinal cord. Neurol Clin1991; 9: 573. Google Scholar 2 : Neurourologic evaluation and urologic management of spinal dysraphism. Neurosurg Clin N Am1995; 6: 269. Google Scholar 3 : Urologic consequences of myelodysplasia and other congenital abnormalities of the spinal cord. Urol Clin North Am1993; 20: 485. Google Scholar 4 : A possible new reflex pathway for micturition after spinal cord injury. Paraplegia1994; 32: 300. Google Scholar 5 : “Skin-CNS-bladder” reflex pathway for micturition after spinal cord injury and its underlying mechanisms. J Urol1999; 162: 936. 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Google Scholar Departments of Urology (C-GX, BL, ZL, MC, Z-HC, PC) and Neurosurgery (M-XD), Tongji Medical College, Xiehe Hospital, Huazhong University of Science and Technology, Wuhan, China, and Division of Biostatistics, Department of Epidemiology and Population Health at Albert Einstein College of Medicine (X-NX), and Department of Urology, New York University School of Medicine (C-GX, ES, HL), New York, New York© 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byWein A (2018) Re: US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year ExperienceJournal of Urology, VOL. 195, NO. 1, (132-133), Online publication date: 1-Jan-2016.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.Park J (2018) The Xiao Procedure—What Have we Learned?Journal of Urology, VOL. 196, NO. 6, (1608-1609), 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.Snow-Lisy D, Yerkes E and Cheng E (2018) Update on Urological Management of Spina Bifida from Prenatal Diagnosis to AdulthoodJournal of Urology, VOL. 194, NO. 2, (288-296), Online publication date: 1-Aug-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. Volume 173Issue 6June 2005Page: 2112-2116 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.Keywordssurgical procedures, operativeneural pathwaysspina bifida occultabladder, neurogenicurinationMetricsAuthor Information CHUAN-GUO XIAO More articles by this author MAO-XIN DU More articles by this author BING LI More articles by this author ZHAO LIU More articles by this author MING CHEN More articles by this author ZHAO-HUI CHEN More articles by this author PING CHENG More articles by this author XIAO-NAN XUE More articles by this author ELLEN SHAPIRO More articles by this author HERBERT LEPOR More articles by this author Expand All Advertisement PDF downloadLoading ...