同时刊登了两篇负面评论。特别指出该结果与肖氏此前所说的结果不符。

EDITORIAL COMMENTS
The authors present the first North American experience
with lumbar to sacral nerve rerouting for
patients with spina bifida. The results from this
study and previous animal and clinical studies by
Xiao clearly demonstrate that nerve rerouting produces
a somatic-autonomic or cutaneous/bladder reflex
with stimulation of the lower extremity dermatome.
1 What is also clear is that the clinical
benefit of the procedure is not at all similar to previous
reports.
Although the authors did an excellent job of
following the patients and characterizing their
changes, the results are hard to validate without a
control population going through the same rigorous
surveillance regimen. In particular the improved
bowel continence and minimal changes in bladder
compliance may not be statistically significant. The
fact that most patients were still on clean intermittent
catheterization and none achieved complete
urinary continence is troubling in light of the report
of 87% success with 110 children with spina bifida
presented by Xiao.1 One has to wonder if most of
these children are not voiding volitionally or using
the newly developed cutaneous reflex, and how
much reinnervation has a role in this surgery. Is it
possible that unilateral denervation of the S3 ventral
motor nerve produced improved compliance and
continence, as previously reported in numerous clinical
series?2,3
I congratulate the authors for taking on this challenge.
I hope this study leads to a rebirth or refocus
regarding neurosurgical treatments of neuropathic
bowel and bladder. I strongly agree with the authors
that this procedure should remain on a research
protocol only.
Eric A. Kurzrock
Pediatric Urology
U. C. Davis Children’s Hospital
Sacramento, California

One of the most curious findings is the discrepancy
between urodynamic data and subjective voiding.
One patient exhibited a decrease in capacity and an
absence of reflex arc, and yet he subjectively reported
improved bladder and bowel function! I could
not help but speculate that his voiding after the
procedure could simply be the bladder emptying via
intra-abdominal pressure generation against an
open bladder neck, given his preoperative stress incontinence.
Xiao reported that more than 87% of 110 patients
gained sensation and continence within 1 year (reference
7 in article). In comparison, the current patients
undergoing the identical procedure with the help of
Xiao himself only showed a modest improvement in
objective urodynamic studies and subjective reporting.
Unless the innovators provide a sound argument and
data for the validity of the procedure, there is a great
danger of its improper and rapid adaptation by patients
and the medical community at large.
John M. Park
Department of Urology
University of Michigan Medical School
Ann Arbor, Michigan