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Lam Van Ba O, Barbe MF, Caremel R, Aharony S, Loutochin O, Jacques L, Wood MW, Tiwari E, Tuite GF, Campeau L, Corcos J, Ruggieri MR. Lumbar to sacral root rerouting to restore bladder function in a feline spinal cord injury model: Urodynamic and retrograde nerve tracing results from a pilot study. Neurourol Urodyn 2018; 37:153-162. [PMID: 29314212 DOI: 10.1002/nau.23394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/05/2017] [Indexed: 10/18/2022]
Abstract
AIMS Lumbar to sacral rerouting surgery can potentially allow voiding via a skin-central nervous system-bladder reflex pathway. Here, we assessed if this surgery was effective in treating neurogenic bladder dysfunction/sphincter in felines. METHODS Eight cats underwent spinal cord transection (SCT) at thoracic level 10/11. Unilateral L7 to S1 ventral root anastomosis was performed 1 month later in six cats. Two cats served as transection-only controls. Electrical and manual stimulation of L6-S1 dermatomes, and urodynamics were performed at 3, 5, 7, and 9/10 months post transection. At 9/10 months, cats were also evaluated by direct electrophysiological testing of anastomosed roots with urodynamics, then tissue collection and examination of the root anastomosis site and lumbosacral cord ventral horns for cells retrogradely labeled from tracer dye injected 2 weeks earlier into the bladder wall. RESULTS At 9/10 months, four of six rerouted cats exhibited increased detrusor pressure provoked by cutaneous stimulation, one cat bilaterally. Two cats presented with a voiding stream after ipsilateral cutaneous stimulation at 7 and 9 months. All six rerouted animals showed regrowth of axons from the L7 ventral horn to the bladder, although some aberrant axonal regrowth was also observed. CONCLUSION L7 to S1 ventral root rerouting below the level of SCT showed successful axonal regrowth to the bladder from the L7 spinal cord segment in all rerouted animals, and induced increased detrusor pressure response to cutaneous stimulation in a subset. This feasibility study paves the way for future animal studies for bladder reinnervation.
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Affiliation(s)
- Ornella Lam Van Ba
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Romain Caremel
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Shachar Aharony
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Oleg Loutochin
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Line Jacques
- Department of Neurosurgery, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Matthew W Wood
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ekta Tiwari
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Gerald F Tuite
- Neuroscience Institute, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida.,Shriners Hospital, Philadelphia, Pennsylvania
| | - Lysanne Campeau
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Jacques Corcos
- Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada
| | - Michael R Ruggieri
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.,Shriners Hospital, Philadelphia, Pennsylvania.,Department of Electrical and Computer Engineering, Temple University, Philadelphia, Pennsylvania.,Department of Pharmacology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Tang J, Ma J, Yang L, Huang X, Ge Y, Sui T, Wei Z, Cao X. The feasibility study of extradural nerve anastomosis technique for canine bladder reinnervation after spinal cord injury. J Spinal Cord Med 2016; 39:679-685. [PMID: 27858587 PMCID: PMC5137576 DOI: 10.1080/10790268.2016.1209889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Intradural nerve anastomosis for bladder innervation has been demonstrated to be useful. However, its clinical application remains limited because of the complex surgery, its complications and extensive bony destruction. The purpose of the current study was to demonstrate the feasibility of extradural spinal root anastomosis for bladder innervation in canines. METHODS Ten beagle dogs were used. The length of the extradural segment of the nerve root, upper nerve root outlet (the point at which it emerges from the spinal dura mater) to S2 (dS2), the S3 (dS3) nerve root outlet distance, and the diameters of the extradural spinal roots were measured. The numbers of nerve fibers from L6 to S3 ventral roots were calculated using immunohistochemical staining. RESULTS The extradural spinal roots could be divided into a ventral root (VR) and a dorsal root (DR) before the ganglionic enlargement of the dorsal root, and the extradural motor nerve roots situate ventrally to their corresponding sensory nerve roots. The extradural nerve root lengths of S1 and parts of L7 were longer than the corresponding dS2. The numbers of nerve and motor nerve fibers, and the diameters of extradural nerve roots, were gradually descending from L6 to S3. CONCLUSION The S1 VRs and parts of the L7 VRs can be extradurally anastomosed to the S2 nerves without tension. A nerve graft was needed for extradural anastomosis of L6 VRs and parts of L7 VRs to S2 VRs. This study demonstrated the feasibility of extradural spinal nerve anastomosis for treating neurogenic bladder in canines.
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Affiliation(s)
- Jian Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Ma
- Department of Orthopedics, Affiliated Suqian Hospital of Xuzhou Medical College, Suqian, Jiangsu, China
| | - Lei Yang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinpeng Huang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yingbin Ge
- Department of Physiology, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Sui
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhongqing Wei
- Department of Urology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangs”u China
| | - Xiaojian Cao
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China,Correspondence to: Xiaojian Cao, Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, NO. 300, Guangzhou Road, Nanjing City, Jiangsu Province, China.
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He J, Li G, Luo D, Sun H, Qi Y, Li Y, Jin X. Reconstruction of atonic bladder innervation after spinal cord injury: A bladder reflex arc with afferent and efferent pathways. J Spinal Cord Med 2015; 38:717-28. [PMID: 25582052 PMCID: PMC4725806 DOI: 10.1179/2045772314y.0000000285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Establishing bladder reflex arcs only with the efferent pathway to induce micturition after spinal cord injury (SCI) has been successful. However, the absence of sensory function and micturition desires can lead to serious complications. Objectives To reconstruct a bladder reflex arc with both afferent and efferent pathways to achieve atonic bladder innervation after SCI. Methods A reflex arc was established by microanastomosis of the S2 dorsal root to the peripheral process of the L5 dorsal ganglion and the L5 ventral root to the S2 ventral root. The functions of the reflex arc were evaluated using electrophysiology, wheat germ agglutinin-horseradish peroxidase (WGA-HRP) tracing, and calcitonin gene-related peptide (CGRP) immunocytochemistry analysis. Hind-paw motion was evaluated by CatWalk gait. Results Compound action potentials and compound muscle action potentials were recorded at the right L5 dorsal root following electrical stimulation of right S2 dorsal root. Similar to the control side, these were not significantly different before or after the spinal cord destruction between L6 and S4. WGA-HRP tracing and CGRP immunocytochemistry showed that construction of the afferent and efferent pathways of the bladder reflex arc encouraged axonal regeneration of motor and sensory nerves, which then made contact with the anterior and posterior horns of the spinal cord, ultimately reestablishing axoplasmic transportation. Gait analysis showed that at 3 months following the operation, only the regularity index was significantly different as compared with 1 day before the operation, other parameters showing no difference. Conclusion Bladder reflex arc with the afferent and efferent pathways reconstructs the micturition function without great influence on the motion of leg.
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Affiliation(s)
- Jun He
- Department of Orthopaedics, the Affiliated Nanhua Hospital of University of South China, Hengyang, China
| | - Guitao Li
- Department of Orthopaedics, Guangdong No. 2 Provincial People's Hospital, No. 1 Shiliugang Road, Guangzhou, China
| | - Dixin Luo
- Department of Orthopaedics, Guangdong No. 2 Provincial People's Hospital, No. 1 Shiliugang Road, Guangzhou, China
| | - Hongtao Sun
- Department of Orthopaedics, Guangdong No. 2 Provincial People's Hospital, No. 1 Shiliugang Road, Guangzhou, China
| | - Yong Qi
- Department of Orthopaedics, Guangdong No. 2 Provincial People's Hospital, No. 1 Shiliugang Road, Guangzhou, China
| | - Yiyi Li
- Department of Orthopaedics, Guangdong No. 2 Provincial People's Hospital, No. 1 Shiliugang Road, Guangzhou, China
| | - Xunjie Jin
- Department of Orthopaedics, Guangdong No. 2 Provincial People's Hospital, No. 1 Shiliugang Road, Guangzhou, China,Correspondence to: Xunjie Jin, Department of Orthopaedics, Guangdong No. 2 Provincial People's Hospital, No. 1 Shiliugang Road, Guangzhou 510317, China.
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