Anatomical feasibility of performing a nerve transfer from the femoral branch to bilateral pelvic nerves in a cadaver: a potential method to restore bladder function following proximal spinal cord injury

Brown, Justin M.; Barbe, Mary F.; Albo, Michael; Ruggieri, Michael R.

doi:10.3171/2013.2.spine12793

Cited by 12 publications

(22 citation statements)

References 29 publications

(34 reference statements)

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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%

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%

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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“…The field of neurourology has advanced considerably since these first attempts. Strategies, such as end-to-end root repair, 23, 25, 26, 36, 53, 54 intradural root-to-root crossover repair, 15, 27, 35 spinal-nerve-to-root crossover repair, 22, 24, 30, 42 or the reverse root-to-spinal-nerve repair, 37, 38, 40, 41 direct detrusor reinnervation, 32 transfer of peripheral somatic or autonomic nerves to vesical branches of the pelvic nerve, 17–21, 29, 33–36 and even creation of artificial skin–CNS–bladder pathways, 43–47, 66–68 have been developed to improve the management of NBD based on the concept that axons have the capacity to regenerate in the peripheral and central nervous systems.…”

Section: Resultsmentioning

confidence: 99%

“…They were transected with enough length to reach the interior of the pelvic cavity, and then moved superiorly and tunneled inferior to the inguinal ligament, before moving one branch to the ipsilateral vesical pelvic nerve at the base of the bladder and one branch to the contralateral vesical pelvic nerve. 21 In all studies, the cross-sectional areas of each nerve were of sufficient and similar size for surgical coaptation.…”

Section: Strategies For Bladder Reinnervationmentioning

confidence: 98%

“…20, 21 In pilot studies in 20 cadavers (female or male), the intercostal, ilioinguinal, iliohypogastric, and femoral nerves were exposed, carefully dissected to obtain the longest possible length, and then transected. These nerves, rather than the genitofemoral nerve, were chosen for transfer owing to their greater content of motor axons.…”

Section: Strategies For Bladder Reinnervationmentioning

confidence: 99%

“…First, the main branches of the vesical branches of the pelvic nerve were exposed in the pelvic cavity, and transected. The vesical branches of the pelvic nerve were detected as one or two main trunks at the base of the bladder, inferior to the ureter, and accompanied by inferior vesical vessels in all examined cadavers, 20, 21 We first examined feasibility of transferring the eleventh and twelfth intercostal nerve directly to the vesical branch of the pelvic nerve , but both intercostal nerves were too short for this type of transfer. Therefore, use of a femoral cutaneous nerve branch as a nerve graft was suggested .…”

Section: Strategies For Bladder Reinnervationmentioning

confidence: 99%

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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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Clarification of the Innervation of the Bladder, External Urethral Sphincter and Clitoris: A Neuronal Tracing Study in Female Mongrel Hound Dogs

Barbe

Gomez-Amaya

Salvadeo

et al. 2018

The Anatomical Record

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Many studies examining the innervation of genitourinary structures focus on either afferent or efferent inputs, or on only one structure of the system. We aimed to clarify innervation of the bladder, external urethral sphincter (EUS) and clitoris. Retrograde dyes were injected into each end organ in female dogs. Spinal cord, mid-bladder, and spinal, caudal mesenteric, sympathetic trunk and pelvic plexus ganglia were examined for retrograde dye-labeled neurons. Neurons retrogradely labeled from the bladder were found primarily in L7-S2 spinal ganglia, spinal cord lateral zona intermedia at S1-S3 levels, caudal mesenteric ganglia, T11-L2 and L6-S2 sympathetic trunk ganglia, and pelvic plexus ganglia. The mid-bladder wall contained many intramural ganglia neurons labeled anterogradely from the pelvic nerve, and intramural ganglia retrogradely labeled from dye labeling sites surrounding ureteral orifices. Neurons retrogradely labeled from the clitoris were found only in L7 and S1 spinal ganglia, L7-S3 spinal cord lateral zona intermedia, and S1 sympathetic trunk ganglia, and caudal mesenteric ganglia. Neurons retrogradely labeled from the EUS were found in primarily at S1 and S2 spinal ganglia, spinal cord lamina IX at S1-S3, caudal mesenteric ganglia, and S1-S2 sympathetic trunk ganglia. Thus, direct inputs from the spinal cord to each end organ were identified, as well as multisynaptic circuits involving several ganglia, including intramural ganglia in the bladder wall. Knowledge of this complex circuitry of afferent and efferent inputs to genitourinary structures is necessary to understand and treat genitourinary dysfunction. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.

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Anatomical feasibility of performing a nerve transfer from the femoral branch to bilateral pelvic nerves in a cadaver: a potential method to restore bladder function following proximal spinal cord injury

Cited by 12 publications

References 29 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)

Neural reconstruction methods of restoring bladder function

Clarification of the Innervation of the Bladder, External Urethral Sphincter and Clitoris: A Neuronal Tracing Study in Female Mongrel Hound Dogs

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