Urological Outcome of the Xiao Procedure in Children with Myelomeningocele and Lipomyelomeningocele Undergoing Spinal Cord Detethering.
Although previous studies have revealed high success rates (70% to 85%) after an intradural somatic-to-autonomic nerve transfer procedure in children with spinal dysraphism, no study has had a control group or blinded observers. We report a rigorously designed study to investigate the effectiveness of the Xiao procedure.



Children with neurogenic bladder dysfunction related to myelomeningocele or lipomyelomeningocele who required spinal cord detethering were randomized to 2 groups at surgery, with half undergoing only spinal cord detethering and half undergoing the Xiao procedure in addition to detethering. Double-blind evaluations were performed at regular intervals during the 3-year followup.



A total of 10 patients underwent spinal cord detethering only and 10 underwent detethering plus the Xiao procedure. The Xiao procedure did not result in voluntary voiding or continence in any patient, but patients undergoing spinal cord detethering plus the Xiao procedure were more likely to have greater improvements in total bladder capacity, bladder overactivity and overall quality of life than those who underwent detethering only. By the end of the study no participant or evaluator was able to accurately predict to which group the patients had been assigned.



The results of this randomized controlled trial are in agreement with recently published similarly poor results of the Xiao procedure in patients with spinal cord injury. Improvements in bladder parameters observed in this study may be related to sacral nerve root section, a necessary portion of the Xiao procedure, instead of reinnervation. Confirmatory animal studies are recommended before further clinical trials of the Xiao procedure are performed in humans.
Division of Pediatric Neurosurgery, Neuroscience Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Tampa, Florida; Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland. Electronic address: gtuite1@jhmi.edu.
Gerald F
GF
Tuite
Department of Urology, University of South Florida, Tampa, Florida.
Yves
Y
Homsy
Department of Urology, University of South Florida, Tampa, Florida.
Ethan G
EG
Polsky
Department of Occupational and Physical Therapy, Johns Hopkins All Children's Hospital, Saint Petersburg, Tampa, Florida.
Margaret A
MA
Reilly
Division of Pediatric Neurosurgery, Neuroscience Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Tampa, Florida; Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida.
Carolyn M
CM
Carey
Division of Pediatric Neurology, Department of Pediatrics, University of South Florida, Tampa, Florida.
S Parrish
SP
Winesett
Division of Pediatric Neurosurgery, Neuroscience Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Tampa, Florida; Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida.
Luis F
LF
Rodriguez
Division of Pediatric Neurosurgery, Neuroscience Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Tampa, Florida; Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida.
Bruce B
BB
Storrs
Division of Pediatric Neurosurgery, Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida.
Sarah J
SJ
Gaskill
Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, Saint Petersburg, Tampa, Florida.
Lisa L
LL
Tetreault
Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, Saint Petersburg, Tampa, Florida.
Denise G
DG
Martinez
Clinical and Translational Research Organization, Johns Hopkins All Children's Hospital, Saint Petersburg, Tampa, Florida.
Ernest K
EK
Amankwah
D002648:Child; D004311:Double-Blind Method; D006801:Humans; D008591:Meningomyelocele / Q000150:complications* / Q000601:surgery*; D016067:Nerve Transfer; D019635:Neurosurgical Procedures / Q000379:methods*; D013116:Spinal Cord / Q000601:surgery*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000601:surgery*
nerve transfer; neural tube defects; spinal dysraphism; urination