Surgery May Aid Bladder Control After Spinal Cord Injury

[manouli]

THIS IS COOL YEA?


Monday, February 19, 2007

Surgery May Aid Bladder Control After Spinal Cord Injury

Needing a wheelchair isn't always the biggest complaint of people left paralyzed by spinal cord injury - it's also the loss of bladder control. Recently, Michigan doctors began a unique experiment to see if rerouting patients' nerves just might fix that problem.

It's a delicate operation: Surgeons cut open a spot on the spine and sew two normally unrelated nerves together ---- one from the bladder to one from the thigh ---- with a single hair-thin stitch. It will take months for this new nerve bridge to heal, an anxious waiting period for the first volunteers.

But if it works, merely scratching the thigh should signal the bladder to empty, allowing patients to ditch their despised catheters and restore a longed-for degree of freedom, as well as fewer bladder infections and other serious complications.

"I've got nothing to lose by doing this," is the way a cautiously hopeful Kevin Bryant, 19 and paralyzed from the waist down by a car crash, approached the experiment.

It's a technique pioneered in China that is starting to garner international attention ---- and surgeons at William Beaumont Hospital in Royal Oak, Mich., hope their new U.S. study will prove if the approach really is a solution for at least some patients.

"We're very excited," says Dr. Kenneth Peters, Beaumont's urology research chief, who headed a team of doctors that traveled to China last February to watch Dr. Chuan-Gao Xiao operate at the Huazhong University of Science and Technology.

"We said, 'This is something we need to study ... to see if we can reproduce this in the U.S.,"' adds Peters, who in turn invited Xiao into Beaumont's operating room. If the results hold up, "it would allow us to treat those patients who have no other alternatives."

Monday's first volunteer: a 49-year-old paralyzed from a car crash, Kevin Conkey of Fenton, Mich. Bryant, the 19-year-old paraplegic, was also set to undergo the procedure ---- in addition to a child with spina bifida, an improperly formed spinal cord that can cause similar bladder dysfunction.

MORE:
http://www.sci-info-pages.com/2007/0...rol-after.html

[Scott Buxton]

Some thoughts - One scratches (sensory nerve) as if an itch , but that scratch activates a motor nerve rerouted to bladder sphincter and bladder wall. Is it the same nerve or different? Does it cause AD? Scott.

[antiquity]

First, surgeons remove a piece of bone alone the lower spine to expose spaghetti-like nerve roots beneath. They reconnect a lumbar nerve responsible for thigh sensation to a sacral nerve that would normally open the bladder.

I wonder if this would negatively affect regeneration potential when a cure is found?

The good news is that they're further along than the Duke University team.

And it will be expensive, about $30,000 to $40,000 a person, he estimated, a tab Beaumont is funding through a private donor.

Wow, this is very kind and generous of that person.

Since they're charging, I assume this isn't a clinical trial. Sounds like the hospitals IRB give them permission to do this without FDA oversight. Interesting.

[Scott Buxton]

My friend gets Autonomic Dysrefexia when Voiding happens to spontaneously occur. A Foley in-dwelling catheter seems to allow constant voiding and still prevent AD.

A peripheral nerve rerouting (so he could scratch his side), a pacemaker (Medtronic's Interstim or VoCare or something I recently read about on sciencedaily.com) could make the bladder void, BUT would it also cause AD?

Is AD caused by certain sensory nerves whereas a pacemaker (or nerve rerouting) would work with different nerves?

Scott.