Restoration of normal micturition in SCI patients is a major goal in neuro-urology. The ideal therapy would be to achieve repair of the injured spinal cord, but this is not feasible at the present time. Thus, other procedures have been deployed, including intermittent catheterization, electrical stimulation of the sacral ventral roots, continence diversion and external sphincterotomy [1–3]. Unfortunately, these approaches have hardly led to satisfactory outcomes in the majority of SCI cases. Recently, Xiao et al. reported a series of experimental and clinical studies attempting to establish a “skin-central nervous system (CNS)-bladder” reflex pathway to trigger bladder contraction [4–6]. However, this technique was useful only in the cases of spastic bladder incurred by supraconal injuries. Clinically, fracture-dislocation of the spinal column was most commonly witnessed in the thoracolumbar region (T12/L1), This is more likely to result in damage to the spinal cone and bladder center, triggering hypotonia and decreased bladder contractile strength. This study was performed in an attempt to demonstrate that restoration of autonomic micturition in the atonic bladder by re-establishment of afferent and efferent nerve pathways is achievable.
Compound Muscle Action Potential Ventral Root Nerve Graft Control Side Bladder Smooth Muscle
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Brindley GS, Polkey CE, Rushton DN. Sacral anterior root stimulator for bladder control in paraplegia: the first 50 cases. J Neurol Neurosurg Psych. 1986;49:1004–14.CrossRefGoogle Scholar
Tanagho EA, Schmidt RA. Electrical stimulation in the clinical management of the neurogenic bladder. J Urol. 1988;140:1331–9.PubMedGoogle Scholar
Mitchell ME, Kulb TB, Backes DJ. Intestinocystoplasty in combination with clean intermittent catheterization in the management of vesical dysfunction. J Urol. 1986;136:288–91.PubMedGoogle Scholar
Xiao CG, Godec CJ. A possible new reflex pathway for micturition after spinal cord injury. Paraplegia. 1994;32:300–7.PubMedCrossRefGoogle Scholar
Xiao CG, de Groat WC, Godec CJ, Dai C, Xiao Q. “Skin-CNS-bladder” reflex pathway for micturition after spinal cord injury and its underlying mechanisms. J Urol. 1999;162:936–42.PubMedCrossRefGoogle Scholar
Xiao CG, Du MX, Dai C, Li B, Nitti VW, de Groat WC. An artificial somatic-central nervous system-autonomic reflex pathway for controllable micturition after spinal cord injury: preliminary results in 15 patients. J Urol. 2003;170:1237–41.PubMedCrossRefGoogle Scholar
Vorstman B, Schlossberg S, Landy H, Kass L. Nerve crossover technique for urinary bladder rennervation: animal and human cadaver studies. J Urol. 1987;137:1043–7.PubMedGoogle Scholar
Chuang DC, Chang PL, Cheng SY. Root reconstruction for bladder reinnervation: an experimental study in rats. Microsurgery. 1991;12:237–45.PubMedCrossRefGoogle Scholar
Carlsson CA, Sundin T. Reconstruction of efferent pathway to the urinary bladder in a paraplegic child. Rev Surg. 1967;24:73–6.PubMedGoogle Scholar
Sundin T, Carlsson CA. Reconstruction of severed dorsal roots innervating the urinary bladder. An experimental study in cats. II. Regeneration studies. Scand J Urol Nephrol. 1972;6:185–96.PubMedCrossRefGoogle Scholar
Vorstman B, Schlossberg S, Kass L. Investigations on urinary bladder reinnervation: historical perspective and review. Urology. 1987;30:89–96.PubMedCrossRefGoogle Scholar
Lin H, Hou C, Zhong G, et al. Reconstruction of reflex pathways to the atonic bladder after conus medullaris injury: preliminary clinical results. Microsurgery. 2008;28:429–35.PubMedCrossRefGoogle Scholar
Lin H, Hou C, Zhen X, Xu Z. Clinical study of reconstructed bladder innervation below the level of spinal cord injury to produce urination by Achilles tendon-to-bladder reflex contractions. J Neurosurg Spine. 2009;10:452–7.PubMedCrossRefGoogle Scholar