AN EFFECTIVE SURGICAL TREATMENT FOR NEUROGENIC BLADDER IN SPINA BIFIDA CHILDREN : RESULTS OF 20 CASES

Author(s): Chuan-Guo Xiao*, New York, NY; Maoxin Du, Bing Li, Zhao Liu, Ping Chen, Ming Chen, Wuhan, China.

INTRODUCTION AND OBJECTIVE: Neurogenic bladder is a major dysfunction with no satisfactory treatment in spina bifida patients. After the successful establishment by surgery of a skin-CNS-bladder reflex pathway in spinal cord injury patients for controllable micturition, we performed the procedure on 20 spina bifida cystica children with follow-up for 1-3 years.
METHODS: All spina bifida cystica children with neurogenic bladder underwent limited laminectomy and a lumbar ventral root (VR, usually L5) to S3 VR micro-anastomosis, The L5 dorsal root (DR) was left intact as the trigger of micturition after axonal regeneration. The mean follow-up period was 2 years. All patients underwent urodynamic evaluation before surgery and during follow-up.
RESULTS: Preoperative urodynamic studies revealed 2 types of bladder dysfunction: areflexic bladder with real incontinence (n=16, 80%) or hyperreflexic bladder with DESD manifested as overflow incontinence (n=4, 20%). Sixteen of the 20 patients gained satisfactory bladder control and continence within 8-12 months after VR microanastomosis. For 13 of the 16 patients with areflexic bladder, the average bladder capacity increased from 72ml to 210ml, and the detrusor became contractile with a pressure over 33 cmH20. For 3 of the 4 patients with hyperreflexic bladder, urodynamic studies revealed a change from detrusor hyperreflexia with DESD and high detrusor pressure to nearly normal storage and synergic voiding after the surgery. Average residual urine decreased from 282 ml to 38 ml and urinary infection as well as overflow incontinence disappeared. Four failed to exhibit any improvement.
CONCLUSIONS: The artificial somatic-CNS-autonomic reflex arc procedure is an effective and safe treatment for spina bifida patients to gain bladder control and continence.