Neural Reconstruction Methods of Restoring Bladder Function

Gomez-Amaya, Sandra; Barbe, Mary F.; Groat, William C. de; Brown, Justin M.; Tuite, Gerald F.; Corcos, Jacques; Fecho, Susan B.; Ruggieri, Michael R.

doi:10.1016/b978-0-12-802653-3.00072-5

Cited by 6 publications

(12 citation statements)

References 68 publications

(132 reference statements)

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“…8,11,26 The lack of efficacy of the Xiao procedure performed in our study might also be explained by the difficulties we encountered in sacral nerve root selection. Anatomical identification of the S-2, S-3, and S-4 roots was not difficult after electrical stimulation and mapping of the potential donor nerves, but we found the selection of the specific sacral nerve root unsettling from an electrophysiological standpoint.…”

Section: Limitations Of the Studymentioning

confidence: 82%

“…4,5,9,10,13,15,21,25,[28][29][30] For more than 100 years, researchers and clinicians have pursued a myriad of surgical remedies to allow reinnervation of the urinary bladder, attempting a variety of nerve repair and transfer techniques in experimental animals and in humans. 11 While there has been great success in the clinical use of nerve transfer techniques to reinnervate peripheral nerves of the extremities, 3 there is no surgical nerve transfer or repair procedure that is widely used in patients with neurogenic bladder dysfunction. 11 A recent review outlines many of the surgical techniques that have been pursued, 11 including the "skin-CNS-bladder" reflex pathway that was developed by Xiao et al in a rat model more than 20 years ago.…”

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confidence: 99%

“…11 While there has been great success in the clinical use of nerve transfer techniques to reinnervate peripheral nerves of the extremities, 3 there is no surgical nerve transfer or repair procedure that is widely used in patients with neurogenic bladder dysfunction. 11 A recent review outlines many of the surgical techniques that have been pursued, 11 including the "skin-CNS-bladder" reflex pathway that was developed by Xiao et al in a rat model more than 20 years ago. 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.…”

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confidence: 99%

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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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Section: Limitations Of the Studymentioning

confidence: 82%

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confidence: 99%

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confidence: 99%

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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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“…, Gomez‐Amaya et al . ) are often accompanied by urinary tract dysfunction. Improved overall survival of patients suffering from according pathologies are accompanied by an increasing relevance of these dysfunctions, which may severely affect the quality of life and ability to participate in day‐to‐day activities.…”

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confidence: 99%

Waterworks

Persson

2015

Acta Physiologica

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“…We are hopeful that future animal and basic science research will provide more hope than the nerve transfer surgical techniques that have been pursued over the past century. 1 Finally, we are hopeful that our experience performing a study that randomizes patients between different surgical arms will embolden other clinical investigators in pediatric surgical fields to more carefully consider an RCT when designing clinical research. Despite what is commonly suggested, we found that parents and their children were willing to randomize between surgical arms, once we explained the rationale of our study and the risks involved.…”

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confidence: 99%