1009 OUTCOME OF INTRASPINAL NERVE RE-ROUTING TO RE-ESTABLISH BLADDER FUNCTION IN SPINAL CORD INJURED PATIENTS: A SINGLE CENTER EXPERIENCE
2010-03-23

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction1 Apr 20101009 OUTCOME OF INTRASPINAL NERVE RE-ROUTING TO RE-ESTABLISH BLADDER FUNCTION IN SPINAL CORD INJURED PATIENTS: A SINGLE CENTER EXPERIENCE Karl-Dietrich Sievert, Bastian Amend, Florian Roser, Marcos Tatagiba, and Arnulf Stenzl Karl-Dietrich SievertKarl-Dietrich Sievert More articles by this author , Bastian AmendBastian Amend More articles by this author , Florian RoserFlorian Roser More articles by this author , Marcos TatagibaMarcos Tatagiba More articles by this author , and Arnulf StenzlArnulf Stenzl More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2023AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The standard treatment for spinal cord injured (SCI) patients with neurogenic bladder dysfunction includes self-intermittent catheterization and the use of anticholinergics or botulinumtoxin A in the case of detrusor overactivity. The only possibility to initiate spontaneous voiding seemed to be sacral neuromodulation with an additional deafferentiation of the S2-S4 sacral roots. Based on previous reports with successfully treated patients, we offered restoration of the lower urinary tract (LUT) function using an intraspinal nerve re-routing creating a skin-spinal cord-bladder reflex pathway for micturition. This investigation presents the clinical and urodynamic results of eight patients. METHODS From 02/2005 to 08/2007 we performed the intraspinal unilateral nerve re-routing from the L5 to S3 in 8 SCI patients (mean age=30 years) suffering from upper motor neuron disease (C6-Th10). The average time between injury and surgery was 77.3 months (range 4-288 months). The clinical (mean=41 months) and urodynamics follow-up (mean=27 months) was possible in 6 of 8 patients. The patients were evaluated with repeated urodynamics (every 3-6 months depending on current results) including clinical visitation. The interim analysis included a specialized questionnaire. RESULTS There were no operative or severe postoperative complications. Currently, none of the patients can initiate spontaneous micturition by selective forced-rubbing of the skin dermatome as performed immediately after surgery. In one patient micturition was initiated during urodynamics by electrical skin stimulation. Two of 8 patients reported a slight amelioration of bowel movement and UTI reduction. No significant changes were identified with regard to bladder sensitivity, catheterization frequency or urinary incontinence occurrences. The following urodynamic changes were measured: the max. bladder capacity decreased from 346ml (SD=140) to 293 (SD=211) and the max. detrusor pressure reduced from 61 cmH2O (SD=31) to 40 (SD=25). There was no significant difference in the presence of detrusor sphincter dyssynergy. CONCLUSIONS Although intraspinal nerve re-routing is a safe surgical procedure, none of our patients reached the primary goal of voluntary micturition. Some patients benefited from slight effects in bowel function and reduced UTI rates. In summary further investigations including standardized treatment protocols are necessary to identify the potential of sacral nerve re-rerouting as previously published. Tuebingen, Germany© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e392 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karl-Dietrich Sievert More articles by this author Bastian Amend More articles by this author Florian Roser More articles by this author Marcos Tatagiba More articles by this author Arnulf Stenzl More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...