Ipsilateral S2 nerve root transfer to pudendal nerve for restoration of external anal and urethral sphincter function: an anatomical study

Zhu, Lei; Zhou, Zhengming; Shen, Di; Chen, Aimin

doi:10.1038/s41598-019-50484-7

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…For example, transferring intercostal nerves or the T11, L5, or S1 ventral root to the ventral S2/S3 root helps reestablish bladder reflex arcs. Successful outcomes typically result in regained bladder control within 8–12 months, representing a breakthrough for patients with lower-level SCIs 13 , 36 – 40 , 63 .…”

Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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Background: The review highlights recent advancements and innovative uses of nerve transfer surgery in treating dysfunctions caused by central nervous system (CNS) injuries, with a particular focus on spinal cord injury (SCI), stroke, traumatic brain injury, and cerebral palsy. Methods: A comprehensive literature search was conducted regarding nerve transfer for restoring sensorimotor functions and bladder control following injuries of spinal cord and brain, across PubMed and Web of Science from January 1920 to May 2023. Two independent reviewers undertook article selection, data extraction, and risk of bias assessment with several appraisal tools, including the Cochrane Risk of Bias Tool, the JBI Critical Appraisal Checklist, and SYRCLE’s ROB tool. The study protocol has been registered and reported following PRISMA and AMSTAR guidelines. Results: Nine hundred six articles were retrieved, of which 35 studies were included (20 on SCI and 15 on brain injury), with 371 participants included in the surgery group and 192 in the control group. These articles were mostly low-risk, with methodological concerns in study types, highlighting the complexity and diversity. For SCI, the strength of target muscle increased by 3.13 of Medical Research Council grade, and the residual urine volume reduced by more than 100 ml in 15 of 20 patients. For unilateral brain injury, the Fugl-Myer motor assessment (FMA) improved 15.14–26 score in upper extremity compared to 2.35–26 in the control group. The overall reduction in Modified Ashworth score was 0.76–2 compared to 0–1 in the control group. Range of motion (ROM) increased 18.4–80° in elbow, 20.4–110° in wrist and 18.8–130° in forearm, while ROM changed −4.03°−20° in elbow, −2.08°−10° in wrist, −2.26°−20° in forearm in the control group. The improvement of FMA in lower extremity was 9 score compared to the presurgery. Conclusion: Nerve transfer generally improves sensorimotor functions in paralyzed limbs and bladder control following CNS injury. The technique effectively creates a ‘bypass’ for signals and facilitates functional recovery by leveraging neural plasticity. It suggested a future of surgery, neurorehabilitation and robotic-assistants converge to improve outcomes for CNS.

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Section: Discussionmentioning

confidence: 99%

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Xiang,

Wu,

et al. 2024

International Journal of Surgery

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Clinical Anatomy of the Sacral Nerve Roots and Its Relevance to Their Reconstruction After Sacrectomy

Kaiser,

Khadanovich,

Benes

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: En bloc sacrectomy is associated with sacral root transection causing loss of urinary bladder, rectum, and sexual function. The aim of the study was to determine the position of the pudendal branches (sensorimotor) and pelvic splanchnic nerves (parasympathetic) on the sacral roots relative to the sacrum, and the minimal and maximal defects in the sacral roots that can be reconstructed by grafting after various types of sacrectomy. METHODS: Five cadaveric pelves were dissected bilaterally. The lengths and widths of the S1-S4 roots and their branches were measured. Then, the minimal and maximal defects between the proximal and distal stumps of the sacrificed roots were measured following 3 models of sacrectomy (below S2, below S1, and total sacrectomy). RESULTS: The mean distance of the splanchnic nerves from the S2 and S3 anterior sacral foramina was 17.7 ± 7.3 and 23.6 ± 11.1 mm, respectively, and the mean distance of the pudendal S2 and S3 branches was 36.8 ± 13.7 and 30.2 ± 10.8 mm, respectively. The mean widths of the S2 and S3 roots were 9.3 ± 1.9 and 5.4 ± 1.2 mm, respectively. The mean maximal defects in S2 and S3 roots after various types of sacrectomies were between 61.8 ± 16.3 and 100.7 ± 14.3 mm and between 62.7 ± 20.2 and 84.7 ± 25.1 mm, respectively. There were no statistically significant differences between sides or sexes for all obtained measurements. CONCLUSION: The reconstruction of the S2-S3 roots is anatomically feasible after partial or total sacrectomies in which the resection of the soft tissue does not extend further than approximately 1.5 to 2 cm ventrally from the sacrum.

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Buccal mucosal graft urethroplasty of the bulbomembranous part of urethra

Vorobev

Белобородов

Seminskiy

et al. 2020

Cent european J Urol

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Introduction Urethral stricture is a partial or complete narrowing of the urethra, caused by damage to the urethral epithelium. This disease leads to a persistent urination dysfunction, the elimination of which is a difficult task. The aim of this study was to perform a comparative analysis of the immediate and long-term narrowing treatment results of the proximal part of the bulbar and membranous urethral parts using the developed magnifying and anastomotic methods. Material and methods A total of 102 patients with a confirmed diagnosis of stricture of the bulbomembranous urethral part of the urethra who underwent treatment in the urological hospital in Irkutsk City Clinical Hospital No. 1 during the period 2012–2018 participated in this prospective study. Urethroplasty operations were performed in two ways, using the anastomotic and intra-urethral substitution techniques. Through the assessment of preoperative parameters, statistical homogeneity of comparison groups was established. Results The final data analysis showed relapse for 4 patients from Group I and for 2 patients in Group II. The absence of relapse during the entire observation period was equal in both groups and after 2 years amounted to 83.0 ±7.9% in Group I and 92.5 ±5.1% in Group II. Conclusions In both groups, the desired result was achieved – adequate independent urination was restored. The anastomotic method of urethroplasty should be used with caution in patients at risk groups, as well as with the presence of predictors of complications: previous transurethral surgeries on the urethra and prostate, anastomotic urethroplasty, radical prostatectomy. The developed minimally invasive substitution technique has a similar effectiveness with a lower risk of complications.

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Ipsilateral S2 nerve root transfer to pudendal nerve for restoration of external anal and urethral sphincter function: an anatomical study

Cited by 3 publications

References 30 publications

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Peripheral nerve transfers for dysfunctions in central nervous system injuries: a systematic review

Clinical Anatomy of the Sacral Nerve Roots and Its Relevance to Their Reconstruction After Sacrectomy

Buccal mucosal graft urethroplasty of the bulbomembranous part of urethra

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