Reestablishment of artificial bladder reflex arc for the treatment of neurogenic bladder after spinal cord injury, a clinical study

English Keywords:Spinal cord injury  Neurogenic bladder  Micturition  Reflex arc  Urodynamic study

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcomes of re-establishment of the artificial bladder reflex arc with the normal reflex pathway to restore functions of neurogenic bladder after spinal cord injury. Methods: Reconstruction of the artificial reflex arc was performed on 36 patients with complete spinal cord injury(ASIA: A), including 28 patients(spastic bladder) with spinal cord injury above the conus medullaris undergoing unilateral microanastomosis of S1 anterior roots to main bladder innervating roots(S2 or S3) and 8 patients(atonic bladder) with conus medullaris injury undergoing unilateral microanastomosis of the T10/T11 ventral root to main bladder innervating ventral root with sural nerve. Micturition function of 34 patients(2 patients with spastic bladder died) were followed up and examined by urodynamic examination (rate of flooding of NS was 25ml/s) postoperatively at the 6th, 12th, 18th month respectively to evaluate the function recovery of spastic bladder and flaccid bladder. Two different types of neurogenic bladder patients were selected asrepresentative of urodynamics index, statistic analysis of data. Results: 26 spastic bladder patients were included in this series. Three times of sample collection of subjects′ maximum cystometric capacity were conducted at pre- and post-operation respectively. No significant difference(P>0.05) was noted among 3 postoperative time point results; however significant difference was noted when compared with the pre-operative result(P<0.05). The index of volume of residual and bladder compliance presented significant difference between 2 groups respectively(P<0.05). While for 8 atonic bladder patients with the same method, there was no significant difference(P>0.05) mutually on maximum cystometric capacity as the pre- and post-operation respectively. Volume of residual decrease from the pre-operation value 495.1±56.6ml to the post-operation value 264.4±30.8ml, it showed a significant difference with the pre-operative patients themselves(P<0.05). Pdet.max went up to the post-operation value 82.9±4.3cmH2O from the pre-operation value 6.3±3.9cmH2O, there was a significant difference with the pre-operative(P<0.05). There was no case micturates caused by scratching abdomen skin in the two case studies. Conclusions: Using the normal reflex pathway to reconstruct artificial reflex arc for treating bladder functions is feasible.