An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida

Chuan Guo Xiao, Mao Xin Du, Bing Li, Zhao Liu, Ming Chen, Zhao Hui Chen, Ping Cheng, Xiao Nan Xue, Ellen Shapiro, Herbert Lepor

Research output: Contribution to journalArticle

73 Scopus citations

Abstract

Purpose: Neurogenic bladder is a major problem for children with spina bifida. Despite rigorous pharmacological and surgical treatment, incontinence, urinary tract infections and upper tract deterioration remain problematic. We have previously demonstrated the ability to establish surgically a skin-central nervous system-bladder reflex pathway in patients with spinal cord injury with restoration of bladder storage and emptying. We report our experience with this procedure in 20 children with spina bifida. Materials and Methods: All children with spina bifida and neurogenic bladder underwent limited laminectomy and a lumbar ventral root (VR) to S3 VR microanastomosis. The L5 dorsal root was left intact as the afferent branch of the somatic-autonomic reflex pathway after axonal regeneration. All patients underwent urodynamic evaluation before and after surgery. Results: Preoperative urodynamic studies revealed 2 types of bladder dysfunction-areflexic bladder (14 patients) and hyperreflexic bladder with detrusor external sphincter dyssynergia (6). All children were incontinent. Of the 20 patients 17 gained satisfactory bladder control and continence within 8 to 12 months after VR microanastomosis. Of the 14 patients with areflexic bladder 12 (86%) showed improvement. In these cases bladder capacity increased from 117.28 to 208.71 ml, and mean maximum detrusor pressure increased from 18.35 to 32.57 cm H20. Five of the 6 patients with hyperreflexic bladder demonstrated improvement, with resolution of incontinence. Urodynamic studies in these cases revealed a change from detrusor hyperreflexia with detrusor external sphincter dyssynergia and high detrusor pressure to nearly normal storage and synergic voiding. In these cases mean bladder capacity increased from 94.33 to 177.83 ml, and post-void residual urine decreased from 70.17 to 23.67 ml. Overall, 3 patients failed to exhibit any improvement. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)2112-2116
Number of pages5
JournalJournal of Urology
Volume173
Issue number6
DOIs
StatePublished - Jun 2005

Keywords

  • Bladder, neurogenic
  • Neural pathways
  • Spina bifida occulta
  • Surgical procedures, operative
  • Urination

ASJC Scopus subject areas

  • Urology

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    Xiao, C. G., Du, M. X., Li, B., Liu, Z., Chen, M., Chen, Z. H., Cheng, P., Xue, X. N., Shapiro, E., & Lepor, H. (2005). An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida. Journal of Urology, 173(6), 2112-2116. https://doi.org/10.1097/01.ju.0000158072.31086.af