Selective Sacral Rhizotomy in Children with High Pressure Neurogenic Bladders: Preliminary Results

Franco, Israel; Storrs, Bruce B.; Firlit, Casimir F.; Zebold, K.; Richards, I. D. G.; Kaplan, William E.

doi:10.1016/s0022-5347(17)36681-8

Cited by 14 publications

(4 citation statements)

References 11 publications

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“…This procedure had proven effective for other patients and has been described by one of the authors (B.B.S.). 2,7 At the time of selective sacral rhizotomy, the previously performed left L-5 to left S2-3 anastomosis was identified and found to be in anatomical continuity with expected scar tissue surrounding the nerve. Electrical stimulation of the nerve above and below the anastomosis produced no contractions of the bladder as measured by a bladder wall electrode placed through a suprapubic incision.…”

Section: Effect Of Surgery On Bowel and Erectile Functionmentioning

confidence: 99%

Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis

Tuite

Storrs

Homsy³

et al. 2013

PED

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An intradural somatic-to-autonomic anastomosis, or Xiao procedure, has been described to create a “skin-CNS-bladder” reflex that improves bladder and bowel function in patients with neurogenic bladder and bowel dysfunction. The authors present their experience with a 10-year-old boy with chronic neurogenic bladder and bowel dysfunction related to spinal cord injury who underwent the Xiao procedure. After undergoing a left L-5 ventral root to left S2–3 intradural anastomosis, the patient reported that his bladder and bowel dysfunction improved between 6 and 12 months. Two years after the procedure, however, he reported that there was no change in his bladder or bowel dysfunction as compared with his condition prior to the procedure. Frequent, systematic multidisciplinary evaluations produced conflicting data. Electrophysiological and histological evaluation of the previously performed anastomosis during surgical reexploration 3 years after the Xiao procedure revealed that the anastomosis was in anatomical continuity but neuroma formation had prevented reinnervation. Nerve action potentials were not demonstrable across the anastomosis, and stimulation of the nerve above and below the anastomosis created no bladder or perineal contractions. This is the first clinical report on the outcome of the Xiao procedure in a child with spinal cord injury outside of China. It is impossible to draw broad conclusions about the efficacy of the procedure based on a single patient with no demonstrable benefit. However, future studies should carefully interpret transient improvements in bladder function, urodynamic findings, and the patient's ability to void in response to scratching after the Xiao procedure. The authors' experience with the featured patient, in whom reinnervation could not be demonstrated, suggests that such changes could be related to factors other than the establishment of a skin-CNS-bladder reflex as a result of a somatic-to-autonomic anastomosis.

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Section: Effect Of Surgery On Bowel and Erectile Functionmentioning

confidence: 99%

Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis

Tuite

Storrs

Homsy³

et al. 2013

PED

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“…Sacral rhizotomy, also known as sacral deafferentation (SDAF), has achieved some success in reducing DO (16,(223)(224)(225)(226)(227), but it is used nowadays mostly as an adjuvant to sacral anterior root stimulation (228)(229)(230)(231)(232)(233)(234)(235)(236)(237)(238)(239). Alternatives for rhizotomy are sought in this treatment combination (240)(241)(242).…”

Section: 43mentioning

confidence: 99%

Forty-five-year follow-up on the renal function after spinal cord injury

et al. 2016

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“…1,2 Therefore, it is reasonable to convert a spastic bladder that has neither storing nor voiding functions into a flaccid bladder that has good storing function. The simplest method for achieving these goals involves destroying the nerves responsible for triggering reflex bladder contractions, for example sacral nervectomy, complete sacral rhizotomy and selective sacral rhizotomy [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] . Clinically, various combinations of selective sacral rhizotomy have been practiced.…”

Section: Discussionmentioning

confidence: 99%

“…Bladder denervation by resection of the sacral roots (common, anterior or posterior roots) to convert a spastic bladder to a balanced or flaccid bladder and restore good reservoir function has been practiced for about half a century [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] . In 1977, McGuire and Wagner 19 demonstrated that only complete severance of the S2-S4 roots (whether the common, anterior, or posterior roots) could result in prolonged eradication of detrusor and sphincter responses to bladder filling, thus achieving a permanently areflexic bladder with a lower pressure storing function.…”

Section: Introductionmentioning

confidence: 99%

Staggered rhizotomy of anterior and posterior sacral roots for bladder reservoir function in spinal cord injury: a canine experimental study and preliminary clinical report

Chang

Hou

2009

Orthopaedic Surgery

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Selective Sacral Rhizotomy in Children with High Pressure Neurogenic Bladders: Preliminary Results

Cited by 14 publications

References 11 publications

Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis

Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis

Forty-five-year follow-up on the renal function after spinal cord injury

Staggered rhizotomy of anterior and posterior sacral roots for bladder reservoir function in spinal cord injury: a canine experimental study and preliminary clinical report

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