Department of Urology, Lady Davis Research Institute and McGill University, Montreal, Quebec, Canada.
Department of Anatomy and Cell Biology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Neurourol Urodyn. 2018 Jan;37(1):153-162. doi: 10.1002/nau.23394. Epub 2018 Jan 4.
Lumbar to sacral rerouting surgery can potentially allow voiding via a skin-central nervous system-bladder reflex pathway. Here, we assessed if this surgery was effective in treating neurogenic bladder dysfunction/sphincter in felines.
Eight cats underwent spinal cord transection (SCT) at thoracic level 10/11. Unilateral L7 to S1 ventral root anastomosis was performed 1 month later in six cats. Two cats served as transection-only controls. Electrical and manual stimulation of L6-S1 dermatomes, and urodynamics were performed at 3, 5, 7, and 9/10 months post transection. At 9/10 months, cats were also evaluated by direct electrophysiological testing of anastomosed roots with urodynamics, then tissue collection and examination of the root anastomosis site and lumbosacral cord ventral horns for cells retrogradely labeled from tracer dye injected 2 weeks earlier into the bladder wall.
At 9/10 months, four of six rerouted cats exhibited increased detrusor pressure provoked by cutaneous stimulation, one cat bilaterally. Two cats presented with a voiding stream after ipsilateral cutaneous stimulation at 7 and 9 months. All six rerouted animals showed regrowth of axons from the L7 ventral horn to the bladder, although some aberrant axonal regrowth was also observed.
L7 to S1 ventral root rerouting below the level of SCT showed successful axonal regrowth to the bladder from the L7 spinal cord segment in all rerouted animals, and induced increased detrusor pressure response to cutaneous stimulation in a subset. This feasibility study paves the way for future animal studies for bladder reinnervation.
腰骶神经再分配手术可能通过皮肤-中枢神经系统-膀胱反射途径实现排尿。本研究旨在评估该手术治疗猫神经性膀胱功能障碍/括约肌功能障碍的效果。
8 只猫在第 10/11 胸椎进行脊髓横断（SCT）。1 个月后，6 只猫进行单侧 L7 到 S1 腹根吻合术。2 只猫作为单纯横断对照组。在 SCT 后 3、5、7 和 9/10 个月，对 L6-S1 皮节进行电刺激和手动刺激，并进行尿动力学检查。在 9/10 个月，还通过将示踪剂染料注入膀胱壁后 2 周，对吻合根进行直接电生理测试和尿动力学检查，然后对吻合根部位和腰骶脊髓腹角进行组织收集和检查，以评估逆行标记的细胞，对所有 6 只再分配猫进行评估。
在 9/10 个月时，6 只再分配猫中有 4 只表现出皮肤刺激引起的逼尿肌压力增加，其中 1 只为双侧。2 只猫在 7 和 9 个月时对同侧皮肤刺激出现排尿流。所有 6 只再分配动物的 L7 腹角均有轴突再生到膀胱，但也观察到一些异常的轴突再生。
SCT 以下的 L7 到 S1 腹根再分配显示，所有再分配动物的 L7 脊髓节段的轴突均成功再生到膀胱，并在部分动物中引起逼尿肌对皮肤刺激的压力反应增加。这项可行性研究为未来的膀胱神经再支配动物研究铺平了道路。
