送交者: xj 于 2005-9-12, 21:01:03:
回答: xj请进 由 NYUxy 于 2005-9-12, 20:10:20:
not many people know the urology conference abstract unless....:-)
I agree that the results are encouraging but the abstract is too simple given that you reported only two patients. It seems to me that the surgery in the US is still considered to be preliminary. This is understandable. But again this said that you did clinical trial in China.
By the way, I did see the editorial. Howevever, I am not qualified to judge your achievement although I know J of Urology is considered to be prestigious in the urology field, unless you get something to NEJM. Unfortunately, the SCI impact factor for J of Urology may not be impressive.
My institution doesn't have subscription for online natural clinical practice Urology.
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CREATION OF A SOMATIC-AUTONOMIC REFLEX PATHWAY FOR TREATMENT OF NEUROGENIC BLADDER IN PATIENTS WITH SPINAL CORD INJURY: PRELIMINARY RESULTS OF FIRST 2 USA PATIENTS
Christopher E Kelly*, Chuan-Guo Xiao, Howard Weiner, Aleksandar Beric, Victor W Nitti, Herbert Lepor, New York, NY
INTRODUCTION AND OBJECTIVE: Management of neurogenic bladder in patients with spinal cord injury (SCI) is varied, but traditional care mainly involves anticholinergics and invasive catheterizations. We performed a surgical procedure to establish a somatic-autonomic reflex pathway in 2 SCI patients in order to restore bladder function. We report our results with a follow up of 9 and 15 months respectively.
METHODS: We enrolled two spinal cord injured patients with a complete T6 and T11 spinal cord injury respectively; each managed their urinary tract with clean intermittent catheterization; both required anticholinergic therapy to help reduce incontinence. Both underwent a limited laminectomy and a lumbar ventral root (VR, L5) to S3 VR micro-anastomosis. The L5 dorsal root (DR) was left intact as the trigger of micturition after axonal regeneration. All patients underwent videourodynamic and questionnaire evaluation of urinary, bowel and sexual function pre- and post-operatively.
RESULTS:Pre-operative urodynamic assessment in both patients revealed neurogenic detrusor overactivity with urinary incontinence with detrusor sphincter dysynergia (DESD). At six months, we observed a significant decrease in neurogenic overactivity on filling cystometry. Also, L5 stimulation precipated detrusor contractions in both patients (range 5-52 cm H20). At last follow-up (15 months) L5 stimulation caused a detrusor contraction of 59 cm H20, a Q max of 8 cc/sec and no DESD. Voided volume was 150cc and post-void residual was 200 cc’s. Also, at 15 months, our patient has no need for anticholinergics or catheterizations. Bowel function questionnaire revealed significant improvement in one patient and no significant change in the other. No change in sexual function was reported. The only complication related to this procedure was mild headache for three days post-operatively in one patient.
CONCLUSIONS: Preliminary results of this novel somatic-autonomic reflex procedure indicate that this surgical therapy may be an effective and safe treatment for spinal cord injured patients to gain urinary and bowel control.
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