title: Challenges for Restoration of Lower Urinary Tract Innervation in Patients with Spinal Cord Injury: A European Single-center Retrospective Study with Long-term Follow-up.
abstract: Xiao and colleagues in China reported successful restoration of bladder control in patients with spinal cord injury (SCI) by establishing a somatic-autonomic reflex pathway through lumbar-to-sacral ventral root nerve rerouting. We evaluated long-term results in eight patients who underwent this procedure at a German university clinic between 2005 and 2007. The primary outcome was the occurrence of voiding upon stimulation of the skin, with normalization of bladder pressure when filling, as assessed with videourodynamics at each visit. Videourodynamic variables, urinary tract infections, and bladder/stool events recorded in a patient diary were stored in a prospective database and reviewed retrospectively. Intraoperative testing indicated successful nerve rerouting in all eight patients. Duration of follow-up was 71 mo (range: 56-86). No patient reached the primary goal of voluntary voiding with normalization of detrusor pressure at any point during follow-up. No improvements in videourodynamic or diary variables regarding bladder function were observed. In view of the lack of short (12-18 mo) and long-term (71 mo) success in our patients and others, the risks of any surgical procedure using general anesthesia, and potential for unmet expectations to wreak havoc on patient emotional well-being, we cannot recommend this procedure for patients with SCI.
  
  
  
  Although the hope was to improve long-term outcomes of spinal cord injury patients, intraspinal nerve rerouting did not improve or normalize bladder function. In view of the lack of success, we cannot recommend this procedure until proven in clinical studies.
authors.affiliation: Department of Urology, University of Tubingen, Tubingen, Germany; Department of Urology and Andrology, SALK University Clinic/Paracelsus Medical University (PMU), Salzburg, Austria. Electronic address: kd_sievert@hotmail.com.
authors.forename: Karl-Dietrich
authors.initials: KD
authors.lastname: Sievert
authors.affiliation: Department of Urology, University of Tubingen, Tubingen, Germany.
authors.forename: Bastian
authors.initials: B
authors.lastname: Amend
authors.affiliation: Department of Neurosurgery, University of Tubingen, Tubingen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Roser
authors.affiliation: Spinal Cord Unit, BG Trauma Center, Tubingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Badke
authors.affiliation: Department of Urology, University of Tubingen, Tubingen, Germany.
authors.forename: Patricia
authors.initials: P
authors.lastname: Toomey
authors.affiliation: Spinal Cord Unit, BG Trauma Center, Tubingen, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Baron
authors.affiliation: Department of Neurosurgery, Sankt Gertrauden-Krankenhaus, Berlin, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kaminsky
authors.affiliation: Department of Urology, University of Tubingen, Tubingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: Department of Neurosurgery, University of Tubingen, Tubingen, Germany.
authors.forename: Marcos
authors.initials: M
authors.lastname: Tatagiba
mesh_terms: D017776:Autonomic Pathways; D002574:Cervical Vertebrae; D004558:Electric Stimulation; D005500:Follow-Up Studies; D006801:Humans; D012189:Retrospective Studies; D012867:Skin / Q000294:innervation; D013119:Spinal Cord Injuries / Q000150:complications*; D013126:Spinal Nerve Roots / Q000601:surgery*; D013904:Thoracic Vertebrae; D013997:Time Factors; D001743:Urinary Bladder / Q000294:innervation* / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D053201:Urinary Bladder, Overactive / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014554:Urination; D014563:Urodynamics
keywords: Detrusor sphincter dyssynergia; Incontinence; Lower urinary tract rehabilitation; Nerve regeneration; Nerve rerouting; Neurogenic bladder dysfunction; Reflex pathway; Urinary bladder innervation