Volume 170, Issue 4, Part 1, Pages 1237-1241 (October 2003)

45 of 121

ABSTRACT

FULL TEXT

FULL-TEXT PDF (157 KB)

GET FULL TEXT ELSEWHERE

CITATION ALERT

CITED BY

RELATED ARTICLES

EXPORT CITATION

EMAIL TO A COLLEAGUE

RIGHTS/PERMISSIONS

DOWNLOAD IMAGES

NEED REPRINTS?

BOOKMARK ARTICLE

An 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†, WILLIAM C. de GROAT
Accepted 9 May 2003.

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. Nerve impulses delivered from the efferent neurons of a somatic reflex arc can be transferred to initiate the response of an autonomic effector.

Key Words: spinal cord injuries , bladder , urination , bladder, neurogenic , Laminectomy , neurons, efferent

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