Feasibility of a femoral nerve motor branch for transfer to the pudendal nerve for restoring continence: a cadaveric study

Barbe, Mary F.; Brown, Justin M.; Pontari, Michel A.; Dean, Gregory; Braverman, Alan S.; Ruggieri, Michael R.

doi:10.3171/2011.6.spine11163

Cited by 21 publications

(19 citation statements)

References 22 publications

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“…In addition, our cadaver studies showed feasibility of the use of motor branches of the femoral nerve as a donor nerves for bladder and urethra reinnervation in humans. 11, 22 …”

Section: Discussionmentioning

confidence: 99%

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Bladder Reinnervation Using a Primarily Motor Donor Nerve (Femoral Nerve Branches) is Functionally Superior to Using a Primarily Sensory Donor Nerve (Genitofemoral Nerve)

et al. 2015

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Purpose To determine whether transfer of a primarily motor nerve (Femoral, F) to the anterior vesicle branch of the pelvic nerve (PN) allows more effective bladder reinnervation than a primarily sensory nerve (genitofemoral, GF). Methods Forty-one female mongrel hounds underwent bladder decentralization, decentralization and then bilateral nerve transfer (GFNT and FNT) or were sham/unoperated controls. Decentralization was achieved by bilateral transection of all sacral roots that induce bladder contractions upon electrical stimulation. The retrograde neuronal labeling dye fluorogold was injected into the bladder 3 weeks prior to euthanasia. Results Increased detrusor pressure after direct stimulation of the transferred nerve, lumbar spinal cord or spinal roots was observed in 12/17 GFNT dogs (mean detrusor pressure = 7.6±1.4 cmH2O) and in 9/10 FNT-V dogs (mean detrusor pressure = 11.7±3.1 cm H2O). The mean detrusor pressures after direct electrical stimulation of transferred femoral nerves were statistically significantly greater than after stimulation of the transferred genitofemoral nerves. Retrogradely labeled neurons from the bladder observed in upper lumbar cord segments after GFNT and FNT confirmed bladder reinnervation as did labeled axons at the nerve transfer site. Conclusions While transfer of either a mixed sensory and motor nerve (GFN) or a primarily motor nerve (FN) can reinnervate the bladder, using a primarily motor nerve provides greater return of nerve-evoked detrusor contraction. This surgical approach may be useful for patients with lower motor spinal cord injury to accomplish bladder emptying.

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“…In addition, our cadaver studies showed feasibility of the use of motor branches of the femoral nerve as a donor nerves for bladder and urethra reinnervation in humans. 11, 22 …”

Section: Discussionmentioning

confidence: 99%

“…Ten dogs underwent left FNT to the bilateral vesicle branches of the PN (Fig. 1C) as described 7, 11 without nerve cuff electrodes; 5 with (FNT-V) and 5 without vesicostomies (FNT-NV).…”

Section: Methodsmentioning

confidence: 99%

Bladder Reinnervation Using a Primarily Motor Donor Nerve (Femoral Nerve Branches) is Functionally Superior to Using a Primarily Sensory Donor Nerve (Genitofemoral Nerve)

et al. 2015

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“…Over the past two decades, a variety of nerve transfer procedures have been designed to improve function following nerve loss with the upper and lower extremities, as well as the brachial plexus; however the use for sacral nerve root reconstruction have not been reported . Recently, the obturator nerve has been identified as a distal donor nerve for neurotization of the femoral nerve within the leg; however its use within the pelvis has not been examined .…”

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confidence: 99%

Anatomical feasibility of the anterior obturator nerve transfer to restore bowel and bladder function

et al. 2014

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Total sacrectomies are radical procedures required to treat tumorigenic processes involving the sacrum. The purpose of our anatomical study was to assess the feasibility of a novel nerve transfer involving the anterior obturator nerve to the pudendal and pelvic nerves to the rectum and bladder. Anterior dissection of the obturator nerve was performed in eight hemipelvis cadaver specimens. The common obturator nerve branched into the anterior and posterior at the level of the obturator foramen. The anterior branch then divided into two separate branches (adductor longus and gracilis). The branch to the gracilis was on average longer and also larger than the branch to the adductor longus (8.7 ± 2.1 cm vs. 6.7 ± 2.6 cm in length and 2.6 ± 0.2 mm vs 1.8 ± 0.4 mm in diameter). Each branch of the anterior obturator was long enough to reach the pelvic nerves. The novel transfer of the anterior branch of the obturator nerve to reinnervate the bladder and bowel is anatomically feasible. This represents a promising option with minimal donor site deficit.

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“…18, 33 In the cadavers, we exposed branches of the femoral nerve to the vastus medialis and intermedialis muscles using an anterior thigh approach. Then, the pudendal nerve was exposed in the Alcock (pudendal) canal using a perineal approach, before transferring the femoral nerve branches medially and superiorly to the pudendal nerve.…”

Section: Strategies For Bladder Reinnervationmentioning

confidence: 99%

“…Then, the pudendal nerve was exposed in the Alcock (pudendal) canal using a perineal approach, before transferring the femoral nerve branches medially and superiorly to the pudendal nerve. 18 …”

Section: Strategies For Bladder Reinnervationmentioning

confidence: 99%

Neural reconstruction methods of restoring bladder function

et al. 2015

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During the past century, diverse studies have focused on the development of surgical strategies to restore function of a decentralized bladder after spinal cord or spinal root injury via repair of the original roots or by transferring new axonal sources. The techniques included end-to-end sacral root repairs, transfer of roots from other spinal segments to sacral roots, transfer of intercostal nerves to sacral roots, transfer of various somatic nerves to the pelvic or pudendal nerve, direct reinnervation of the detrusor muscle, or creation of an artificial reflex pathway between the skin and the bladder via the central nervous system. All of these surgical techniques have demonstrated specific strengths and limitations. The findings made to date already indicate appropriate patient populations for each procedure, but a comprehensive assessment of the effectiveness of each technique to restore urinary function after bladder decentralization is required to guide future research and potential clinical application.

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Feasibility of a femoral nerve motor branch for transfer to the pudendal nerve for restoring continence: a cadaveric study

Cited by 21 publications

References 22 publications

Bladder Reinnervation Using a Primarily Motor Donor Nerve (Femoral Nerve Branches) is Functionally Superior to Using a Primarily Sensory Donor Nerve (Genitofemoral Nerve)

Bladder Reinnervation Using a Primarily Motor Donor Nerve (Femoral Nerve Branches) is Functionally Superior to Using a Primarily Sensory Donor Nerve (Genitofemoral Nerve)

Anatomical feasibility of the anterior obturator nerve transfer to restore bowel and bladder function

Neural reconstruction methods of restoring bladder function

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