Outcomes of Lumbar to Sacral Nerve Rerouting for Spina Bifida

No AccessJournal of UrologyPediatric Urology1 Aug 2010Outcomes of Lumbar to Sacral Nerve Rerouting for Spina Bifida Kenneth M. Peters, Benjamin Girdler, Cindy Turzewski, Gary Trock, Kevin Feber, William Nantau, Brian Bush, Jose Gonzalez, Evan Kass, Juan de Benito, and Ananias Diokno Kenneth M. PetersKenneth M. Peters Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Benjamin GirdlerBenjamin Girdler Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Cindy TurzewskiCindy Turzewski Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Gary TrockGary Trock Ministrelli Program for Urology Research and Education (MPURE), Department of Neurology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Kevin FeberKevin Feber Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , William NantauWilliam Nantau Ministrelli Program for Urology Research and Education (MPURE), Department of Clinical Neurophysiology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Brian BushBrian Bush Ministrelli Program for Urology Research and Education (MPURE), Department of Clinical Neurophysiology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Jose GonzalezJose Gonzalez Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Evan KassEvan Kass Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , Juan de BenitoJuan de Benito Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author , and Ananias DioknoAnanias Diokno Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.03.058AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Restoring bladder and bowel function in spina bifida by creation of a skin-central nervous system-bladder reflex arc via lumbar to sacral nerve rerouting has a reported success rate of 87% in China. We report 1-year results of the first North American trial on nerve rerouting. Materials and Methods: Nine subjects were enrolled in the study. Intradural lumbar to sacral nerve rerouting was performed. Subjects underwent urodynamic testing with stimulation of the cutaneous dermatome and careful neurological followup. Adverse events were closely monitored along with changes in bowel and bladder function. Results: At 1 year 7 patients (78%) had a reproducible increase in bladder pressure with stimulation of the dermatome. Two patients were able to stop catheterization and all safely stopped antimuscarinics. No patient achieved complete urinary continence. The majority of subjects reported improved bowel function. One patient was continent of stool at baseline and 4 were continent at 1 year. Of the patients 89% had variable weakness of lower extremity muscle groups at 1 month. One child had persistent foot drop and the remainder returned to baseline by 12 months. Conclusions: At 1 year a novel reflex arc with stimulation of the appropriate dermatome was seen in the majority of subjects. Improvements in voiding and bowel function were noted. Lower extremity weakness was mostly self-limited, except in 1 subject with a persistent foot drop. More patients and longer followup are needed to assess the risk/benefit ratio of this novel procedure. References 1 : Prevalence of spina bifida at birth—United States, 1983-1990: a comparison of two surveillance systems. MMWR Morb Mortal Wkly Rep1996; 45: 15. Google Scholar 2 : A possible new reflex pathway for micturition after spinal cord injury. J Urol1990; 143: 356A. Google Scholar 3 : A possible new reflex pathway for micturition after SCI. Paraplegia1994; 325: 300. Google Scholar 4 : Skin-CNS-bladder reflex pathway for micturition after spinal cord injury and its underlying mechanisms. J Urol1999; 162: 936. 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Google Scholar © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTuite G, Homsy Y, Polsky E, Reilly M, Carey C, Winesett S, Rodriguez L, Storrs B, Gaskill S, Tetreault L, Martinez D and Amankwah E (2016) Urological Outcome of the Xiao Procedure in Children with Myelomeningocele and Lipomyelomeningocele Undergoing Spinal Cord DetetheringJournal of Urology, VOL. 196, NO. 6, (1735-1740), Online publication date: 1-Dec-2016.Gomez-Amaya S, Barbe M, Brown J, Lamarre N, Braverman A, Massicotte V and Ruggieri M (2014) Bladder Reinnervation Using a Primarily Motor Donor Nerve (Femoral Nerve Branches) is Functionally Superior to Using a Primarily Sensory Donor Nerve (Genitofemoral Nerve)Journal of Urology, VOL. 193, NO. 3, (1042-1051), Online publication date: 1-Mar-2015.Rasmussen M, Rawashdeh Y, Clemmensen D, Tankisi H, Fuglsang-Frederiksen A, Krogh K and Christensen P (2014) The Artificial Somato-Autonomic Reflex Arch Does Not Improve Lower Urinary Tract Function in Patients with Spinal Cord LesionsJournal of Urology, VOL. 193, NO. 2, (598-604), Online publication date: 1-Feb-2015. Volume 184 Issue 2 August 2010 Page: 702-708 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.Keywordsnerve transferspina bifida cysticaspina bifida occultaurinary bladderneurogenicAcknowledgmentsC. G. Xiao provided guidance in developing the trial and expertise in training the surgeons involved.Metrics Author Information Kenneth M. Peters Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Benjamin Girdler Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Cindy Turzewski Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Gary Trock Ministrelli Program for Urology Research and Education (MPURE), Department of Neurology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Kevin Feber Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author William Nantau Ministrelli Program for Urology Research and Education (MPURE), Department of Clinical Neurophysiology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Brian Bush Ministrelli Program for Urology Research and Education (MPURE), Department of Clinical Neurophysiology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Jose Gonzalez Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Evan Kass Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Juan de Benito Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Ananias Diokno Ministrelli Program for Urology Research and Education (MPURE), Department of Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Expand All Advertisement PDF downloadLoading ...