Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

14:03 - 14:06

S1-12

(PP)

THE CREATION OF THE SKIN-CNS-BLADDER REFLEX ARC - AN EXPERIMENTAL

VERIFICATION

Pavel ZERHAU

, Matej HUSÁR

, Zdenek MACKERLE

, Eva BRICHTOVA

, Daniela SOCHURKOVA

, Martin KUBÁT

, Eduard

GOPFERT

and Martin FALDYNA

1) Clinic of Paediatric Surgery, Orthopaedics and Traumatology, University Hospital Brno, Paediatric Urology, Brno,

CZECH REPUBLIC - 2) Clinic of Neurosurgery, University Hospital of St.Anna, Brno, Neurosurgery, Brno, CZECH

REPUBLIC - 3) Veterinary Research Institute Brno, Brno, CZECH REPUBLIC

PURPOSE

Somatic-to-autonomic ventral root anastomosis remains an insufficiently verified neurogenic bladder treatment method.

Specifically, possible detrusor-sphincter synergy during artificial stimulation is unclear and requires verification.

MATERIAL AND METHODS

During 2012 and 2014, 34 male rabbits underwent laminectomy. Under electromyographic (EMG) and urodynamic

controls, ventral spinal roots leading to suitable musculocutaneous segments (donor, L5-S1) and detrusor muscle

(recipient, S1-S2) were located, resected and intradural anastomosis of donor and recipient root was performed. After

8-16 months (mean 11), the artificial reflex arc's function was examined (to date in 13 rabbits). Skin segments L5-S1

and the spinal roots above the anastomosis were stimulated, detrusor and sphincter EMG response and intravesical

pressure (Pves) were monitored.

RESULTS

EMG confirmed detrusor response to peripheral skin stimulation in 7 (54%) animals and sphincter response in 8 (62%).

Five (38%) animals displayed elevated Pves up to 15 cm H2O. Root stimulation induced detrusor and sphincter EMG

response in 8 (62%) and 10 (77%) rabbits, respectively, and 4 (31%) animals displayed increased Pves up to 24 cm

H2O. Micturition was not induced in any animals, external sphincter activity was never inhibited. Hind limb paresis

occurred in 2 (15%) animals and spinal lesion in 4 (31%).

CONCLUSIONS

Lumbar-to-sacral-nerve rerouting is a technically manageable method. Only in a limited percentage of cases, however,

can the method achieve positive functional results, i.e. demonstrable detrusor contractions and elevated intravesical

pressure. Physiological micturition without detrusor-sphincter dyssynergia did not occur in our experiment.

Supported by Grant IGA NT 13871-4