[Experimental and clinical studies on selective sacral rhizotomy in treatment of spastic bladder after spinal cord injury].
OBJECTIVE
To observe the effect of selective sacral rhizotomy in treating spastic bladder after spinal cord injury and to explore the mechanism and the best surgical method of different sacral rhizotomies.


METHODS
The spastic bladder models were established in 12 male dogs and were divided into 4 groups according to the different rhizotomies of the sacral nerve as the following: rhizotomy of the anterior root of S2 (group A), rhizotomy of the anterior root of S2 and half of the anterior root of S3 (group B), rhizotomy of the anterior roots of S2 and S3 (group C), and total rhizotomy of the nerve roots of S2-4 (group D). By urodynamic examination and electrophysiological observation, the changes of all functional data were recorded and compared between pre-rhizotomy and post-rhizotomy to testify the best surgical method. In clinical trial, according to the results of the above experiments, rhizotomy of the anterior root of S2 or one of the half-anterior root of S3 were conducted on 32 patients with spastic bladder after spinal cord injury. The mean bladder capacity, the mean urine evacuation and the mean urethra pressure were (120 +/- 30), (100 +/- 30)ml and (120 +/- 20) cm H2O, respectively before rhizotomy.


RESULTS
After rhizotomy, the bladder capacity in 4 groups amounted to (150 +/- 50), (180 +/- 50), (230 +/- 50), and (400 +/- 50) ml, respectively; and the urine evacuation volume were (130 +/- 30), (180 +/- 50), (100 +/- 50) and (50 +/- 30)ml, respectively. In the treated 32 patients, the mean bladder capacity were raised to 410 ml, and the mean urine evacuation volume were also increased to 350 ml. Incontinence of urine disappeared in all patients. After 22-month follow-up on 13 patients, no recurrence was observed.


CONCLUSIONS
The effect of selective sacral rhizotomy in treating spastic cord injury is significant and worthy of further studies.
Department of Othopaedics, Central Hospital of Putuo District, Shanghai 200062, PR China.
Mingxuan
M
Liu
Chunlin
C
Hou
Hao
H
Ding
Haifong
H
Fan
Tongsheng
T
Tang
Xianqi
X
Chen
Jiyong
J
Zhong
D000328:Adult; D000818:Animals; D004285:Dogs; D006801:Humans; D008160:Lumbosacral Plexus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019051:Rhizotomy / Q000379:methods*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000601:surgery; D001743:Urinary Bladder / Q000294:innervation / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery