Some of the most common and serious complications faced by people with spinal cord injuries or spina bifida (a common birth defect) are incontinence and urinary tract infections (UTI). Catheterization and antibiotics have been very effective in controlling these problems, but UTI’s, continence and kidney health are still constant concerns for most. In the last few years, a new treatment has been emerging that may provide a vast improvement to the current methods. In China, a new surgical technique has been explored in both people with spinal cord injuries and in people with spina bifida, and has shown some very promising results.
Bladder Control Surgery: The Procedure
The procedure is called “reinervation of the neurogenic bladder”, which means restoring nerve function to a bladder that is not working well. It involves re-routing the nerve that controls bladder function to a different place on the spine. By using a nerve higher in the spine to control their bladder (usually lumbar 5 or above), the person can cause their bladder to empty by simply scratching their leg in a certain place. This procedure has been performed on both people with spinal cord injuries and on people with spina bifida. In 2003, the results of a clinical study about this was published by a team of researchers from the Tonghi Medical College in China, New York University School of Medicine and University of Pittsburgh School of Medicine. They studied 15 males with spinal cord injuries and found that 13 had improvement in bladder control, a decrease in UTI’s and marked improvement in urodynamic study results within 12-18 months after surgery. In 2005, another study was published that showed similar results in a group of 20 children with spina bifida (17 showed marked improvement). It was later reported in 2006 at an international conference in China that the procedure had been performed on 110 children with spina bifida with an 87% success rate after one year.
Bladder Control Surgery: Future In The U.S.?
There has been great interest in learning more about this surgery in the U.S. and at the first “World Congress on Spina Bifida Research” (a 3-day meeting in Orlando, Florida attended by researchers and physicians from all over the world) in March, 2009, the leading urologist and researcher for this surgery (Dr. CG Xiao) presented and discussed this in detail. Clinical trials for this surgery have begun in the U.S. and interested patients should follow it’s progress.
1) Xiao CG, Du MX, et al. An artificial somatic-central nervous system-autonomic reflex pathway for controllable micturition after spinal cord injury: preliminary results in 15 patients. J Urol. 2003 Oct;170(4 Pt 1):1237-41.
2) Xiao CG, Du MX, et al. An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida. J Urol. 2005 Jun;173(6):2112-6.
3) Xiao CG. Reinnervation for neurogenic bladder: historic review and introduction of a somatic-autonomic reflex pathway procedure for patients with spinal cord injury or spina bifida. Eur Urol. 2006 Jan;49(1):22-8; discussion 28-9.