[Bladder reinnervation with creation of a "somato-autonomic" reflex pathway in spinal cord injured or spina bifida, a new way for treatment?]

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.