2015 AANS Annual Scientific Meeting: Oral Presentations

722. A Randomized, Prospective, Double Blinded Surgical Trial
of a Somatic to Autonomic Intradural Nerve Anastomosis (Xiao
Procedure) in Children with Neurogenic Bladder Undergoing
Spinal Cord Detethering
Gerald F. Tuite, Jr., MD, FAANS; Yves Homsy, MD; Ethan Polsky,
MD; Maggie Reilly; Carolyn Carey, MD; Luis Rodriguez; Parrish
Winesett, MD; Sara Gaskill; Bruce Storrs; Lisa Tetreault (St
Petersburg, FL)
Introduction: Xiao et al have reported 67% to 86% success in
the establishment of voluntary voiding in patients with neurogenic
bladder dysfunction, purportedly the result of the establishment of
a skin‑CNS‑bladder reflex arc created by an intradural somatic to
autonomic lumbosacral nerve anastomosis. We designed a study to
more rigorously analyze this novel procedure, which has generated
great enthusiasm among patients and their physicians, as a possible
transformative new procedure to allow voluntary voiding with
neurogenic bladder dysfunction.
Methods: Twenty children with spina bifida undergoing spinal
cord detethering surgery were randomized between two arms: half
of the patients underwent a standard detethering procedure, with
the other half undergoing detethering plus the Xiao procedure.
Patients, families and health care providers, who were blinded to
the treatment arm, analyzed motor and sensory function, ADLs and
bladder function before surgery and at 3, 6, 9, 12, 24 and 36 months
after surgery using extensive questionnaires, physical examinations
and detailed urodynamic studies.
Results: All 20 patients completed the 3‑year follow‑up evaluation
period. No child in either group had a reproducible, reliable and
useful ability to initiate normal voiding at their three‑year follow‑up.
Early results of over 1,000 clinical outcome data points per patient
will be summarized.
Conclusions: This rigorous evaluation of the Xiao procedure
failed to produce reliable and reproducible improvements in
bladder function or voluntary voiding in children with spina bifida
when compared to patients who underwent a standard spinal cord
detethering procedure.