An Artificial Somatic-Autonomic Reflex Pathway Procedure for Bladder Control in Children With Spina Bifida

Xiao, Chenghan; Du, Mao Xin; Li, Bing; Liu, Zhao; Chen, Ming; Chen, Zhao Hui; Cheng, Peng; Xue, Xiao Nan; Shapiro, Ellen; Lepor, Herbert

doi:10.1097/01.ju.0000158072.31086.af

Cited by 83 publications

(63 citation statements)

References 8 publications

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“…Of course, we are deeply disappointed that none of our patients were able to achieve the dramatic voluntary bladder control that has been described by Xiao and colleagues. 6,7 Our study certainly has limitations, but our results are in agreement with 2 recently published studies of the Xiao procedure in adults with neurogenic bladder dysfunction related to spinal cord injury. Rasmussen et al 4 in Denmark and Sievert et al 5 in Austria both reported a similar lack of effectiveness of the Xiao procedure in their patients with spinal cord injury in very well-designed studies.…”

supporting

confidence: 82%

Response: Some lessons learned from negative results of a randomized controlled trial for bladder reinnervation with the Xiao procedure

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Polsky²,

Homsy³

et al. 2016

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supporting

confidence: 82%

Response: Some lessons learned from negative results of a randomized controlled trial for bladder reinnervation with the Xiao procedure

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Polsky²,

Homsy³

et al. 2016

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“…[16][17][18] Buoyed by the success of the Xiao procedure in patients with spinal cord injury, Xiao et al also applied the technique to children with neurogenic bladder dysfunction related to spina bifida. 36 In 2005, Xiao et al reported that 17 (85%) of 20 children with spina bifida who underwent the procedure had "satisfactory bladder control and continence within 8 to 12 months." 36 Xiao et al described these improvements in bladder function as "remarkable," noting that all but 1 of the patients who voided voluntarily did not even need to initiate the reflex by scratching themselves in the dermatomal distribution of the donor nerve root to empty their bladders.…”

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confidence: 99%

“…36 In 2005, Xiao et al reported that 17 (85%) of 20 children with spina bifida who underwent the procedure had "satisfactory bladder control and continence within 8 to 12 months." 36 Xiao et al described these improvements in bladder function as "remarkable," noting that all but 1 of the patients who voided voluntarily did not even need to initiate the reflex by scratching themselves in the dermatomal distribution of the donor nerve root to empty their bladders. 36 As of 2012, Xiao reported that he and his group had performed the Xiao procedure on 1890 patients with spina bifida in China.…”

mentioning

confidence: 99%

Lack of efficacy of an intradural somatic-to-autonomic nerve anastomosis (Xiao procedure) for bladder control in children with myelomeningocele and lipomyelomeningocele: results of a prospective, randomized, double-blind study

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Polsky²,

Homsy³

et al. 2016

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OBJECTIVE Xiao et al. and other investigators have studied an intradural somatic-to-autonomic (e.g., L-5 to S3–4) nerve transfer as a method to create a reflex arc to allow bladder emptying in response to cutaneous stimulation (the Xiao procedure). In previous clinical studies of patients with spinal dysraphism who underwent the Xiao procedure, high success rates (70%–85%) were reported for the establishment of a “skin-CNS-bladder” reflex arc that allows spontaneous, controlled voiding in children with neurogenic bladder dysfunction. However, many of these studies did not use blinded observers, did not have control groups, and/or featured only limited follow-up durations. METHODS A randomized, prospective, double-blind trial was initiated in March 2009, enrolling children with myelomeningocele (MM), lipomyelomeningocele (LMM), and neurogenic bladder dysfunction who were scheduled for spinal cord detethering (DT) for the usual indications. At the time of DT, patients were randomized between 2 arms of the study: half of the patients underwent a standard spinal cord DT procedure alone (DT group) and half underwent DT as well as the Xiao procedure (DT+X group). Patients, families, and study investigators, all of whom were blinded to the surgical details, analyzed the patients' strength, sensory function, mobility, voiding, and urodynamic bladder function before surgery and at regular intervals during the 3-year follow-up. RESULTS Twenty patients were enrolled in the study: 10 underwent only DT and the other 10 underwent DT+X. The addition of the Xiao procedure to spinal cord DT resulted in longer operative times (p = 0.024) and a greater chance of wound infection (p = 0.03). Patients in both treatment arms could intermittently void or dribble small amounts of urine (< 20% total bladder capacity) in response to scratching in dermatomes T-9 through S-2 using a standardized protocol, but the voiding was not reproducible and the volume voided was not clinically useful in any patient. Voiding in response to scratching was not more frequent in patients who underwent DT+X compared with those who underwent only DT. Bladder contractions in response to scratching occurred in both treatment arms at various intervals after surgery, but they were not more reproducible or more frequent in the patients who underwent the Xiao procedure than in the patients who did not. No patient in either treatment arm was continent of urine before, during, or after the study. CONCLUSIONS Patients with MM and LMM who underwent the Xiao procedure during spinal cord DT were no more likely to be able to void, to control their urination, to achieve continence, or to have a demonstrable urodynamic bladder contraction in response to cutaneous stimulation than patients who underwent only spinal cord DT. This study, in the context of disappointing results reported in other recent studies of the Xiao procedure, raises doubts about the clinical applicability of this procedure in humans until further basic science research is performed.

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“…Peters [48] and Xiao [49,50] demonstrated that the skin-central nervous reflex pathway system following endto-end anastomosis of L5 VR (somatic nerves) to S2/S3 VR (autonomic nerve) could recover controllable voiding function in the clinical trial. However, this method of nerve anastomosis had obvious injury to the donor nerve and affects the donor nerve of somatic motor function.…”

Section: The Advantages Of Terminolateral Neurorrhaphy Of Autonomic-smentioning

confidence: 99%

Terminolateral Neurorrhaphy between Somatic Nerve and Autonomic Nerve

He¹,

Gao²,

Wen³

2018

Neuropsychiatry

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An Artificial Somatic-Autonomic Reflex Pathway Procedure for Bladder Control in Children With Spina Bifida

Abstract: 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.

Cited by 83 publications

References 8 publications

Response: Some lessons learned from negative results of a randomized controlled trial for bladder reinnervation with the Xiao procedure

Response: Some lessons learned from negative results of a randomized controlled trial for bladder reinnervation with the Xiao procedure

Lack of efficacy of an intradural somatic-to-autonomic nerve anastomosis (Xiao procedure) for bladder control in children with myelomeningocele and lipomyelomeningocele: results of a prospective, randomized, double-blind study

Terminolateral Neurorrhaphy between Somatic Nerve and Autonomic Nerve

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