Nerve transfer for restoration of lower motor neuron-lesioned bladder and urethra function: establishment of a canine model and interim pilot study results.
J Neurosurg Spine
; 32(2): 258-268, 2019 Nov 08.
Article
em En
| MEDLINE
| ID: mdl-31703192
ABSTRACT
OBJECTIVE:
Previous patient surveys have shown that patients with spinal cord or cauda equina injuries prioritize recovery of bladder function. The authors sought to determine if nerve transfer after long-term decentralization restores bladder and sphincter function in canines.METHODS:
Twenty-four female canines were included in this study. Transection of sacral roots and hypogastric nerves (S Dec) was performed in 6 animals, and 7 animals underwent this procedure with additional transection of the L7 dorsal roots (L7d+S Dec). Twelve months later, 3 L7d+S Dec animals underwent obturator-to-pelvic nerve and sciatic-to-pudendal nerve transfers (L7d+S Dec+Reinn). Eleven animals served as controls. Squat-and-void behaviors were tracked before and after decentralization, after reinnervation, and following awake bladder-filling procedures. Bladders were cystoscopically injected with Fluoro-Gold 3 weeks before euthanasia. Immediately before euthanasia, transferred nerves were stimulated to evaluate motor function. Dorsal root ganglia were assessed for retrogradely labeled neurons.RESULTS:
Transection of only sacral roots failed to reduce squat-and-void postures; L7 dorsal root transection was necessary for significant reduction. Three L7d+S Dec animals showing loss of squat-and-void postures post-decentralization were chosen for reinnervation and recovered these postures 4-6 months after reinnervation. Each showed obturator nerve stimulation-induced bladder contractions and sciatic nerve stimulation-induced anal sphincter contractions immediately prior to euthanasia. One showed sciatic nerve stimulation-induced external urethral sphincter contractions and voluntarily voided twice following nonanesthetized bladder filling. Reinnervation was confirmed by increased labeled cells in L2 and the L4-6 dorsal root ganglia (source of obturator nerve in canines) of L7d+S Dec+Reinn animals, compared with controls.CONCLUSIONS:
New neuronal pathways created by nerve transfer can restore bladder sensation and motor function in lower motor neuron-lesioned canines even 12 months after decentralization.Palavras-chave
DRG = dorsal root ganglion; EUS = external urethral sphincter; Fluoro-Gold; L7d+S Dec = S Dec plus bilateral transection of L7 dorsal roots; L7d+S Dec+Reinn = L7d+S Dec plus reinnervation; S Dec = sacral root decentralization with exposure and bilateral transection of spinal roots below L7 and hypogastric nerves; awake urodynamic; bladder reinnervation; retrograde dye; spinal cord injury; voiding behavior
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Raízes Nervosas Espinhais
/
Bexiga Urinária
/
Transferência de Nervo
Limite:
Animals
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article