gms | German Medical Science

Introduction: Neurogenic bladder resulted from spinal cord injury (SCI) is a serious problem. To restore functional micturition electrical stimulation has been frequently used. Recently, a new method of reinnervation for neurogenic bladder has been introduced, the “somatic-autonomic reflex pathway procedure” (Xiao CG, 2005). It consists of an anastomosis between a ventral root L5 or S1 and a ventral root S2 or S3, keeping intact the dorsal roots. This artificial somatic-autonomic reflex pathway induces voluntary micturition after mechanical stimulation of skin area of L5 (or S1), whose reflex is now directed to the bladder muscles instead of to patient’s leg. While this method was first described by Urologists, it is widely unknown in Neurosurgery. This surgical procedure is described based on personal experience and review of published cases

Material and methods: Eight patients suffering from SCI and paraplegia underwent the nerve anastomosis. . At the operation a hemilaminectomy at level L4/5 was performed and the ventral nerve roots L5 and S2 were identified by direct electrical stimulation after exposing the intradural space. Electrophysiological monitoring including EMG of all lower extremities muscles and urodynamic studies was followed by a nerve microanastomosis between the ventral root of L5 and S3 unilateral.

Results: Three patient with follow-up (FU) more than 13 months showed some degree of voluntary micturition by scratching the skin area of L5 with reduction of residual bladder volume >50ml. FU of the remaining 5 patients is still too short for evaluation. Review of literature shows satisfactory results in 2/3 of 94 published cases.

Conclusion: The artificial somatic-autonomic reflex pathway procedure seems a promising method to restore voluntary bladder control in patients with SCI and spina bifida.