Functional reinnervation of the canine bladder after spinal root transection and genitofemoral nerve transfer at one and three months after denervation
Functional reinnervation of the canine bladder after spinal root transection and genitofemoral nerve transfer at one and three months after denervation
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DOI：
10.1089/neu.2007.0335
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发表时间：
2008-04-01
影响因子：
4.2
通讯作者：
Barbe, Mary F.
中科院分区：
文献类型：
--
作者：
Ruggieri, Michael R., Sr.;Braverman, Alan S.;Barbe, Mary F.
在脊髓损伤(SCI)患者的即时治疗中，通常会对患者进行一段时间的观察，以确定是否恢复对膀胱功能的自主控制。因此，膀胱神经再支配手术不太可能在损伤后立即进行。我们在犬膀胱去神经后1个月和3个月(切断S1和S2脊神经根)行股-盆神经移位(GF-NT)手术，以确定这种类型的膀胱神经再支配手术是否具有潜在的临床可行性。将神经袖套电极植入骨盆神经移位近端的生殖股神经。膀胱神经再支配的证据包括：(1)电刺激20个神经袖带电极中的4个，增加膀胱压力和尿液流量；(2)双侧盆神经刺激引起膀胱压力和尿液流动，4只失神经动物中3只延迟1个月，6只失神经动物中5只引起3个月延迟；(3)除一侧1只动物外，其余10只动物膀胱内均逆行注射荧光金标记的丰富的L1和L2脊髓细胞体(GF神经的起源)。这项研究提供了初步的概念证明，即GF-NT是一种潜在的可行的临床方法来重新支配下运动神经元受损的膀胱。
In the immediate management of patients with spinal cord injury (SCI), patients are typically observed for a period of time to determine whether voluntary control of bladder function returns. Therefore, bladder reinnervation surgeries are not likely to be performed immediately after the injury. We performed genitofemoral to pelvic nerve transfer (GF NT) surgery in canines at 1 and 3 months after bladder denervation (transection of S1 and S2 spinal roots) to determine whether this type of bladder reinnervation surgery has potential clinical feasibility. Nerve cuff electrodes were implanted on the genitofemoral nerves proximal to the pelvic nerve transfer site. Evidence for bladder reinnervation includes (1) increased bladder pressure and urethral fluid flow following electrical stimulation in four out of 20 nerve cuff electrodes implanted on the transferred GF nerves, (2) bilateral pelvic nerve stimulation induced bladder pressure and urethral fluid flow in three of four denervated animals with 1-month delay GF NT, and in five of six denervated animals with 3-month delay GF NT, and (3) abundant L1 and L2 spinal cord cell bodies (the origin of the GF nerve) retrogradely labeled with fluorogold injected into the bladder in all 10 of the GF NT animals, except one animal on one side. This study presents initial proof of concept that GF NT is a potentially viable clinical approach to reinnervation of the lower motor neuron-lesioned urinary bladder.