Journal of Neurosurgery: Pediatrics
Jul 2013 / Vol. 12 / No. 1 / Pages 80-86

Article
Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis

Case report
Gerald F. Tuite, M.D.1,
Bruce B. Storrs, M.D.1,
Yves L. Homsy, M.D.2,
Sarah J. Gaskill, M.D.3,
Ethan G. Polsky, M.D.2,
Margaret A. Reilly, P.T.4,
Ignacio Gonzalez-Gomez, M.D.5,
S. Parrish Winesett, M.D.3,
Luis F. Rodriguez, M.D.1,
Carolyn M. Carey, M.D.1,
Sharon A. Perlman, M.D.5, and
Lisa Tetreault, R.N.1

1Pediatric Neuroscience Center; 2Departments of Urology, 4Physical Therapy, and 5Pathology and Nephrology, All Children's Hospital, St. Petersburg; 3Department of Neurosurgery and Brain Repair; and 5Department of Pediatrics, Division of Pediatric Nephrology, University of South Florida Morsani College of Medicine, Tampa, Florida

Conclusions

The Xiao procedure performed in a 10-year-old boy with chronic neurogenic bladder and bowel dysfunction did not result in enduring, meaningful improvements in bladder and bowel function, and the child was unable to consistently initiate voiding through a skin-CNS-bladder reflex. Reexploration of the anastomosed nerves 3 years after the Xiao procedure showed neuroma formation. The child did have transient clinical and urodynamic changes, which may be attributable to factors other than reinnervation.

Acknowledgements

The authors thank Chuan-Guo Xiao, M.D., for his instruction in China and for his trip to All Children's Hospital to teach his technique. They also thank Kenneth Peters, M.D., for sharing his experience with the surgical technique and methods for clinical assessment after the Xiao procedure. They thank Jennifer Flanary, R.N., for serving as the initial research nurse for the study; Joanie Cacace, R.N., and Devon Truong, P.A., for their diligent work with detailed urodynamics; Sandy Wismer, Dawn Bruton, and Jay Gould for the clinical research guidance; Christine Hancock, for her administrative assistance; E. Michael Reisman, M.D., Joseph Casadonte, M.D., and Damon Reed, M.D., for serving on the data and safety monitoring board; and Kimberley Carson, for her performance of some physical therapy assessments and her help with the completion of questionnaires.