Neurogenic bladder dysfunction, such as detrusor muscle hyperactivity and dyssynergia with the external urethral sphincter (EUS), are common long-term consequences affecting the wellbeing of patients with spinal cord injury (SCI)
Various studies have investigated surgical strategies to restore function of a decentralized bladder after SCI via repair of the original roots or by transferring new axonal sources
The Finetech-Brindley stimulation device is effective in triggering bladder contraction in patients with neurogenic bladder dysfunction caused by upper motor neuron lesion
Surgical techniques for restoring bladder volume, without also inducing a high increase in bladder pressure, are needed to promote efficient storage and continence
Development of surgical techniques to reinnervate both the detrusor muscle and the EUS are needed to promote coordinated detrusor–EUS function
Comprehensive assessment of the effectiveness of surgical procedures can guide future research and potential clinical application
During the past century, diverse studies have focused on the development of surgical strategies to restore function of a decentralized bladder after spinal cord or spinal root injury via repair of the original roots or by transferring new axonal sources. The techniques included end-to-end sacral root repairs, transfer of roots from other spinal segments to sacral roots, transfer of intercostal nerves to sacral roots, transfer of various somatic nerves to the pelvic or pudendal nerve, direct reinnervation of the detrusor muscle, or creation of an artificial reflex pathway between the skin and the bladder via the central nervous system. All of these surgical techniques have demonstrated specific strengths and limitations. The findings made to date already indicate appropriate patient populations for each procedure, but a comprehensive assessment of the effectiveness of each technique to restore urinary function after bladder decentralization is required to guide future research and potential clinical application.
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The projects described were supported by Award Number R01NS070267 and NS070267-S1 to M.F.B. and M.R.R. from the National Institute of Neurological Disorders and Stroke. The content of this Review is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health.
The authors declare no competing financial interests.
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Gomez-Amaya, S., Barbe, M., de Groat, W. et al. Neural reconstruction methods of restoring bladder function. Nat Rev Urol 12, 100–118 (2015). https://doi.org/10.1038/nrurol.2015.4
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