Reinnervation of the urinary bladder after microsurgical reconstruction of transsected caudal fibres

Conzen, M.; Sollmann, H

doi:10.1007/bf00255957

Cited by 23 publications

(22 citation statements)

References 7 publications

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“…In other studies, the return of bladder contractility has been generally successful. 18,19 Microsurgical repair of nerve roots has been reported previously, but the usefulness of this technique is unclear since the return of the micturition reflex has been documented after simple approximation of nerve ends using a millipore tubulation technique. 20 The time for return of the micturition reflex in these animals who had ventral root only anastomoses varied between 4 and 7 months.…”

Section: Discussionmentioning

confidence: 99%

Reinnervation of the neurogenic bladder in the late period of the spinal cord trauma

Livshits

Catz²,

Folman

et al. 2004

Spinal Cord

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Study design: Intercostal nerve to spinal nerve root anastomosis in chronic spine-injured patients. Objectives: To analyze the effectiveness of neurogenic bladder reinnervation in spinal cordinjured patients through artificial creation of sprouting (intercostal nerve to spinal nerve root anastomosis). Setting: Center of Neurosurgery, Moscow, Russia. Operations were performed by Professor A Livshits. (At present, Professor A Livshits is working at the Spinal Care Unit, Meir General Hospital, Kfar Saba, Israel.) Methods: A total of 11 patients with spinal cord injury of the L1 level were operated on in the late (chronic) stage. The neurological status and urodynamics were investigated before and 12 months after operation. A laminectomy from T11 to L3 was performed. Next, a neurolysis of the 11th and 12th intercostal nerves was carried out, at a distance of 20-21 cm, and transferred to the vertebral canal. The S2-S3 roots were then cut in their proximal portion and anastomosed end-to-end to the intercostal nerves. The results of urodynamic studies were calculated by the Wilcoxon signed rank test for comparison before and 12 months after operation. Results of urodynamic studies: Bladder capacity (ml) before operation -489779, after operation -350739, urine volume (ml) before -18.2717, after -306.4739.8, residual urine (ml) before -459799.4, after -50711.8. Detrusor tone (rel. units) before -0.671.5, after 1.270.2; voiding pressure (cmH 2 O) before -4.475.2, after -30.574.9. Force of detrusor contraction before -575.8, after -32.875.5. Sphincter resistance (cmH 2 O) before -6.573.8, after -21.174.2. Significant improvements in bladder function were observed during the 10th to 12th postoperative months. Restoration of reflex voiding occurred in all patients; in eight of the 11 paresthesic in the groin and scrotum and reappearance of the bulbocavernous, anal and cremasteric reflexes were noted. Conclusion: These results suggest that a restitutive process occurs in the bladder under novel conditions of its nerve supply provided by the intercostal nerve and by new connections established between it and the bladder nerves. Spinal cord lesions that might benefit from nerve crossover surgery would be located at the conus, so functional intercostal nerves could be connected to sacral roots to bypass the injury in an attempt to restore central connections to the bladder.

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Section: Discussionmentioning

confidence: 99%

Reinnervation of the neurogenic bladder in the late period of the spinal cord trauma

Livshits

Catz²,

Folman

et al. 2004

Spinal Cord

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“…Since 1960, much research 2,3,14 has been conducted on intervening directly by repairing severed or severely bruised cauda equina fibres in lumbar fracture/dislocation. More satisfactory recovery is expected from this direct approach, as nerve roots simulate peripheral nerves structurally.…”

Section: Discussionmentioning

confidence: 99%

“…1 Very few attempts have been made to connect torn nerves by microsuture. [2][3][4] Even when such attempts were made, they were rarely successful, because, unlike peripheral nerves, 5 cauda equina nerve roots lacked perineurium to hold the sutured ends securely together. In view of the poor neurological recovery with both of the above-mentioned approaches, particularly in complete injuries, attempt was made by the authors to find a better method of anastomosis to improve outcome.…”

Section: Introductionmentioning

confidence: 99%

The clinical study of repairing cauda equina fibres with fibrin glue after lumbar fracture and dislocation

Sun

Liu

et al. 2010

Spinal Cord

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Study design: A retrospective study. Objectives: To study the outcome of repair of cauda equina fibres with fibrin glue after lumbar fracture and/or dislocation. Methods: Seven acute cases and one chronic case of L2 or L3 fracture and/or dislocation complicated with complete cauda equina injury were selected. Sural nerve or ventral roots of injured cauda equina were chosen to repair the motor cauda equina fibres with fibrin glue after open reduction and internal fixation of the unstable vertebrae. The functional recovery after surgery was observed. Results: Recovery of the strength of thigh muscles (iliopsoas, quadriceps femoris, gluteus maximus, adductors) was observed in all seven acutely injured patients (t ¼ 3.74, Po0.05), but not in the chronic one. Neither recovery of leg muscles nor sensation of the lower extremities was observed in any case. Conclusions: The cauda equina ventral roots injured after lumbar fracture and/or dislocation can be repaired with fibrin glue and motor recovery is expected.

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“…Neurogenic voiding dysfunction and bowel dysfunction resulting from neural tube defects and spinal cord injury (SCI) has been a worldwide medical problem. In the past decades, many clinicians tried to apply various methods for the treatment of neurogenic bladder and bowel dysfunction including drugs, intermittent catheterization, electronic stimulation of sacral nerve roots and so on [39][40][41][42][43][44][45]. However, the effects of these efforts were not ideal.…”

Section: The Advantages Of Terminolateral Neurorrhaphy Of Autonomic-smentioning

confidence: 99%

Terminolateral Neurorrhaphy between Somatic Nerve and Autonomic Nerve

He¹,

Gao²,

Wen³

2018

Neuropsychiatry

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Reinnervation of the urinary bladder after microsurgical reconstruction of transsected caudal fibres

Cited by 23 publications

References 7 publications

Reinnervation of the neurogenic bladder in the late period of the spinal cord trauma

Reinnervation of the neurogenic bladder in the late period of the spinal cord trauma

The clinical study of repairing cauda equina fibres with fibrin glue after lumbar fracture and dislocation

Terminolateral Neurorrhaphy between Somatic Nerve and Autonomic Nerve

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