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发帖数: 684 | 1 Further experimental studies are still required, notably with animals to
confirm the encouraging results of these initial studies, and to better
understand the mechanism before possible routine patient use.
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Bladder reinnervation with creation of a "somato-autonomic" reflex pathway
in spinal cord injured or spina bifida, a new way for treatment?
Nouhaud, F.-X.a , Caremel, R.a , Leroi, A.-M.b , Grise, P.a
a Service d'urologie, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
b Service de physiologie digestive, Urinaire, respiratoire et sportive, CHU
de Rouen, 1, rue de Germont, 76000 Rouen, France
Abstract
Context: The restoration of physiological micturition is a major objective
for patients presenting a medullary injury, which is not possible with
current treatment. Several recent studies have purposed some techniques for
bladder reinnervation. Their purpose was to begin a voluntary micturition by
the stimulation of an artificial reflex arc created by the anastomosis of a
somatic root with a root innervating the bladder. Materials and methods: We
searched on Medline and Cochrane for articles in English. The keywords used
were: bladder reinnervation, spinal cord injury neurogenic bladder, reflex
pathway for micturition. Results: These studies reported a variable efficacy
as high as 85% of the treated patients. These patients could begin
micturition voluntarily, associated with a significant improvement observed
in their postoperative urodynamic evaluation. In fact, an improvement of the
detrusor external sphincter dyssynergia and/or bladder overactivity was
reported, and the patients presented a better quality of life by the control
of their micturition associated with an improvement in continence with no
need for intermittent catheterisation. However, these results were variable
from one study to the other, and certain results seem difficult to explain
notably concerning the abolition of bladder overactivity and the improvement
of the detrusor external sphincter dyssynergia. Conclusion: Further
experimental studies are still required, notably with animals to confirm the
encouraging results of these initial studies, and to better understand the
mechanism before possible routine patient use. © 2011 Elsevier Masson
SAS. |
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