Sievert K-D, Xiao C-G, Hennenlotter J, Seibold J, Merseburger A S, Kaminskie J, Nagele U, Stenzl A
Klinik für Urologie, Universität Tübingen.
Urologe A. 2005 Jul;44(7):756-61. doi: 10.1007/s00120-005-0849-x.
One of the major challenges in neuro-urology is the restoration of voluntary voiding in a patient after spinal cord injury (SCI).
The earliest reports on reconstruction of urinary bladder function by bridging nerve roots from above the SCI to the below this level were published by Carlsson and Sundin 1968. In another approach, a possible reflex pathway below the SCI to reinitiate voluntary voiding was investigated. The result was a modified somatic reflex arc rostral to the sacral spinal micturition center.
Medical reports in numerous publications are still very enthusiastic about the possibility of cell or gene therapy. Such results report the successful bridging of small nerve gaps. The latest approach is the intravenous application of stem cells to aid the recovery of the SCI.
The first reports on attempts to reconstruct the nervous pathways to the bladder in patients were published 1967. In two cases, a nerve anastomosis from Th(12) (the lowest intact segment) to S(2+3), bilaterally to the SCI, allowed spontaneous micturition after 8-12 months with reported sensitivity at the base of the penis. With a modification in surgical technique, another group reported a success rate of 100% using the anastomosis of intercostal nerves Th(11+12) to sacral roots S(2+3) to establish a reflex voiding and, in 72% of patients, reappearance of the bulbocavernous and cremaster reflexes. Xiao et al. published, with a 3 year follow-up, the creation of a micturition reflex through anastomosing the ventral roots of L(5) to S(2/3) in complete SCI patients with a 67% success rate a year after surgery.
There is still a great deal of work required before cell therapy becomes a therapeutic option. Today, the published data strongly suggest that it is possible to treat first line urinary bladder dysfunctions in SCI or spina bifida patients. Before one of these techniques becomes widely used, it should be proven effective in specialized institutions, such as the Department of Urology in collaboration with the Department of Neurosurgery at the University of Tuebingen, Germany.
神经泌尿学的主要挑战之一是脊髓损伤（SCI）患者自主排尿功能的恢复。
1968年，卡尔森（Carlsson）和桑丁（Sundin）发表了最早关于通过将脊髓损伤上方的神经根与损伤下方的神经根连接来重建膀胱功能的报告。在另一种方法中，研究了脊髓损伤下方可能的反射通路以重新启动自主排尿。结果是在骶髓排尿中枢上方形成了改良的躯体反射弧。
众多出版物中的医学报告对细胞或基因治疗的可能性仍非常乐观。此类结果报道了小神经间隙的成功桥接。最新方法是静脉注射干细胞以辅助脊髓损伤的恢复。
1967年发表了关于尝试在患者中重建通往膀胱的神经通路的首批报告。在两例病例中，将胸12（最低完整节段）与双侧脊髓损伤处的骶2 + 3进行神经吻合，8 - 12个月后实现了自主排尿，据报道阴茎根部有感觉。通过改良手术技术，另一组报告使用肋间神经胸11 + 12与骶神经根骶2 + 3吻合建立反射性排尿的成功率为100%，72%的患者球海绵体反射和提睾反射重新出现。肖等人发表了一项为期3年的随访研究，在完全性脊髓损伤患者中通过将腰5腹侧神经根与骶2/3吻合建立排尿反射，术后一年成功率为67%。
在细胞治疗成为一种治疗选择之前，仍有大量工作要做。如今，已发表的数据有力地表明，治疗脊髓损伤或脊柱裂患者的一线膀胱功能障碍是可能的。在这些技术之一被广泛应用之前，应在专业机构（如德国图宾根大学泌尿外科与神经外科合作部门）证明其有效性。
