Background/Aims/Objectives: To verify the transfer of evoked potentials through anastomosis of an experimentally created micturition reflex arc and to detect said potentials directly on the detrusor and sphincter of rabbit urinary bladder. Methods: During 2013-2015, 17 rabbits were operated upon and measurement followed during reoperation 3-16 months later. Suitable ventral spinal roots were electrophysiologically detected following laminectomy, and a somatic-central nervous system-autonomic micturition reflex arc was created. During reoperation, the ventral root was stimulated above and below the anastomosis, the evoked potentials on the bladder detrusor and sphincter were measured, and intravesical pressure was monitored. Results: With stimulation above the anastomosis, 9 animals (53%) displayed a urinary bladder detrusor response and 7 (41%) a sphincter response. Four rabbits (24%) had elevated intravesical pressure. During the control stimulation below the anastomosis, we detected a detrusor response in 7 animals (41%), a sphincter response in 5 (29%), and elevated pressure in 4 (24%). Neither induction of micturition nor decrease in external sphincter activity occurred. Conclusions: Creation of a somatic-CNS-autonomic reflex arc is technically possible. However reflex activity transferring through the anastomosis is detectable on the detrusor only in some individuals, and is unable to induce a micturition reflex with or without accompanying detrusor-sphincter dyssynergia.

Keywords:
Neurostimulation, Nerve rerouting, Micturition reflex arc, Ventral spinal roots, Detrusor response
1.
Ren J, Chew DJ, Thiruchelvam N: Electrical stimulation of the spinal dorsal root inhibits reflex bladder contraction and external urethra sphincter activity: is this how sacral neuromodulation works? Urol Int 2016;96:360-366.
2.
Korzeniecka-Kozerska A, Porowski T, Bagińska J, Wasilewska A: Urodynamic findings and renal function in children with neurogenic bladder after myelomeningocele. Urol Int 2015;95:146-152.
3.
Xiao CG, Godec CJ: A possible new reflex pathway for micturition after spinal cord injury. Paraplegia 1994;32:300-307.
4.
Xiao CG, Du MX, Li B, Liu Z, Chen M, Chen ZH, Cheng P, Xue XN, Shapiro E, Lepor H: An artificial somatic-autonomic reflex pathway procedure for bladder control in children with spina bifida. J Urol 2005;173:2112-2116.
5.
Xiao CG: Reinnervation for neurogenic bladder: historic review and introduction of a somatic-autonomic reflex pathway procedure for patients with spinal cord injury or spina bifida. Eur Urol 2006;49:22-28; discussion 28-29.
6.
Tuite GF, Storrs BB, Homsy YL, Gaskill SJ, Polsky EG, Reilly MA, Gonzalez-Gomez I, Winesett SP, Rodriguez LF, Carey CM, Perlman SA, Tetreault L: Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis. J Neurosurg Pediatr 2013;12:80-86.
7.
Peters KM, Girdler B, Turzewski C, Trock G, Feber K, Nantau W, Bush B, Gonzalez J, Kass E, de Benito J, Diokno A: Outcomes of lumbar to sacral nerve rerouting for spina bifida. J Urol 2010;184:702-708.
8.
Peters KM, Gilmer H, Feber K, Girdler BJ, Nantau W, Trock G, Killinger KA, Boura JA: US pilot study of lumbar to sacral nerve rerouting to restore voiding and bowel function in spina bifida: 3-year experience. Adv Urol 2014;2014:863209.
9.
Rasmussen MM, Rawashdeh YF, Clemmensen D, Tankisi H, Fuglsang-Frederiksen A, Krogh K, Christensen P: The artificial somato-autonomic reflex arch does not improve lower urinary tract function in patients with spinal cord lesions. J Urol 2015;193:598-604.
10.
Xiao CG, de Groat WC, Godec CJ, Dai C, Xiao Q: ‘Skin-CNS-bladder' reflex pathway for micturition after spinal cord injury and its underlying mechanisms. J Urol 1999;162(3 pt 1):936-942.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.