An Artificial Somatic-Central Nervous System-Autonomic Reflex Pathway for Controllable Micturition After Spinal Cord Injury: Preliminary Results in 15 Patients

Chen, Xiao; Du, Mao-Xin; Dai, Chengpu; Li, Bing; Νitti, Victor W.; Groat, William C. de

doi:10.1097/01.ju.0000080710.32964.d0

Cited by 94 publications

(98 citation statements)

References 15 publications

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“…End-to-end anastomosis of injured ventral roots to adjacent intact ventral roots has resulted in bladder improvements in rats (Xiao and Godec, 1994), cats (Carlsson and Sundin, 1968;Vorstman et al, 1986;Xiao et al, 1999), canines (Ruggieri et al, 2004), and humans (Carlsson and Sundin, 1980;Xiao et al, 2003). This procedure requires an additional lesion to uninjured neurons and a shift in function by the originally uninjured neurons to now reinnervate a new target.…”

Section: Reinnervation Of the Lut Function After Injurymentioning

confidence: 99%

“…This procedure requires an additional lesion to uninjured neurons and a shift in function by the originally uninjured neurons to now reinnervate a new target. Furthermore, the intact dorsal roots create a new somatic-CNS-bladder reflex circuitry, whereby scratching the skin in specific dermatomes may elicit bladder contractions (Xiao et al, 1999(Xiao et al, , 2003. Although nerve-to-nerve anastomosis requires peripheral nerve regeneration, our repair model differs in that CNS regeneration is also necessary for reestablishment of the micturition circuitry by the originally injured neurons without inflicting any additional lesions to uninjured neurons.…”

Section: Reinnervation Of the Lut Function After Injurymentioning

confidence: 99%

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Functional Reinnervation of the Rat Lower Urinary Tract after Cauda Equina Injury and Repair

Hoang

Pikov²,

Havton³

2006

J. Neurosci.

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Conus medullaris and/or cauda equina forms of spinal cord injury commonly result in a permanent loss of bladder function. Here, we developed a cauda equina injury and repair rodent model to investigate whether surgical implantation of avulsed lumbosacral ventral roots into the spinal cord can promote functional recovery of the lower urinary tract. Adult female rats underwent sham surgery (n ϭ 6), bilateral L5-S2 ventral root avulsion (VRA) injury (n ϭ 5), or bilateral L5-S2 VRA followed by an acute implantation of the avulsed L6 and S1 ventral roots into the conus medullaris (n ϭ 6). At 12 weeks after operation, the avulsed group demonstrated urinary retention, absence of bladder contractions and external urethral sphincter (EUS) electromyographic (EMG) activation during urodynamic recordings, increased bladder size, and retrograde death of autonomic and motoneurons in the spinal cord. In contrast, the implanted group showed reduced urinary retention, return of reflexive bladder voiding contractions coincident with EUS EMG activation, anatomical reinnervation of the EUS demonstrated by retrograde neuronal labeling, normalization of bladder size, and a significant neuroprotection of both autonomic and motoneurons. In addition, a positive correlation between motoneuronal survival and voiding efficiency was observed in the implanted group. Our results show that implantation of avulsed lumbosacral ventral roots into the spinal cord promotes reinnervation of the urinary tract and return of functional micturition reflexes, suggesting that this surgical repair strategy may also be of clinical interest after conus medullaris and cauda equina injuries.

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Section: Reinnervation Of the Lut Function After Injurymentioning

confidence: 99%

Section: Reinnervation Of the Lut Function After Injurymentioning

confidence: 99%

Functional Reinnervation of the Rat Lower Urinary Tract after Cauda Equina Injury and Repair

Hoang

Pikov²,

Havton³

2006

J. Neurosci.

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“…37 The Xiao procedure aims to establish an "artificial somatic-central nervous system-autonomic reflex" pathway for controlled micturition by modifying spinal cord-mediated reflex arcs, which may be preserved in patients with spina bifida and spinal cord injury. 34,35,37 By transferring the ventral (motor) root from a reflex arc of a somatic nerve (typically L-5 or S-1) to the ventral root of a nerve root that normally controls autonomic functions (typically S-2, S-3, or S-4), Xiao et al reported that patients were able to initiate reproducible bladder contractions and voiding by supplying a sensory stimulus in the distribution of the intact dorsal (sensory) root, at the same level as the somatic donor root (Fig. 1).…”

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

Tuite

Polsky²,

Homsy³

et al. 2016

PED

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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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“…Sauerwein et al described their experience with sacral deafferentation and implant of an anterior root stimulator which restored a normal reservoir function and urinary continence by interrupting the reflex activity, and also decreased episodes of urinary infection from 6.3 to 1.2 per year (14) . On the same line, Groat et al developed a cross-wired skin-central-nervoussystem-bladder reflex pathway that allowed patients to initiate voiding voluntarily by scratching the ipsilateral L5 dermatome, with promising results (15) . Other less invasive procedures showed to be effective in improving the consequences of the detrusor hyperactivity.…”

Section: Discussionmentioning

confidence: 99%

Impact of treadmill gait training with neuromuscular electrical stimulation on the urodynamic profile of patients with high cervical spinal cord injury

D’Ancona

Clilclet

Ikari

et al. 2010

Einstein (São Paulo)

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Objective: To evaluate the impact of gait training with neuromuscular electrical stimulation on urodynamic parameters of patients with neurogenic bladder. Methods: Eight male quadriplegic patients with complete cervical injury level ranging from C4 to C7 comprised the study population. They underwent treadmill gait training with neuromuscular electrical stimulation for six months, only after having their quadriceps and tibialis anterior muscles stimulated for five months in order to support at least 50% of their body weight (pre-gait training). Urodynamic testing was performed before the treadmill gait training and six months after. results: The mean time after cervical lesion was 74.63 months. The urodynamic parameters before and after neuromuscular training by electrical stimulation did not show significant difference. conclusion: This study demonstrated that neuromuscular training with electrical stimulation can benefit the urinary tract. This promising minimally invasive field requires further and more complete studies to confirm a possible benefit to the low urinary tract.Keywords: Spinal cord injuries; Urinary bladder, neurogenic; Urodynamics/physiology; Electric stimulation reSUMO Objetivo: Avaliar o impacto do treinamento neuromuscular, por estimulação elétrica da marcha, nos parâmetros urodinâmicos de pacientes com bexiga neurogênica. Métodos: A população do estudo compreendeu oito pacientes quadriplégicos do sexo masculino com lesão cervical completa nos níveis C4 a C7. Eles foram submetidos a um treinamento neuromuscular por estimulação elétrica da marcha por seis meses, somente após estimulação dos músculos quadríceps e tibial anterior, por cinco meses, de modo a poder suportar 50% de seu peso corporal (pré-treinamento). Testes urodinâmicos foram feitos antes do treinamento e seis meses depois. resultados: O tempo médio após a lesão cervical foi de 74,63 meses. Os parâmetros urodinâmicos antes e depois do treinamento neuromuscular por estimulação elétrica da marcha não mostraram diferença significante. conclusão: Este estudo mostrou que o treinamento neuromuscular com estimulação elétrica pode ser benéfico para o trato urinário. Esse campo, promissor e minimamente invasivo, requer outros estudos mais completos para confirmar um possível benefício no trato urinário inferior.

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An Artificial Somatic-Central Nervous System-Autonomic Reflex Pathway for Controllable Micturition After Spinal Cord Injury: Preliminary Results in 15 Patients

Cited by 94 publications

References 15 publications

Functional Reinnervation of the Rat Lower Urinary Tract after Cauda Equina Injury and Repair

Functional Reinnervation of the Rat Lower Urinary Tract after Cauda Equina Injury and Repair

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

Impact of treadmill gait training with neuromuscular electrical stimulation on the urodynamic profile of patients with high cervical spinal cord injury

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