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DESCRIPTION (provided by applicant): Spina Bifida, a
congenital defect of the spinal cord, causes nerve damage and a
loss of sensation and muscle function below the waist resulting in
bowel, bladder and sexual dysfunction. Patients cannot urinate or
are constantly wet, and this continues throughout life causing
major quality of life and health problems. Clean intermittent
catheterization is usually needed to empty the bladder properly.
Antimuscarinic medications are commonly required to alleviate high
urinary tract pressures that can cause irreversible kidney damage,
where dialysis or kidney transplant is the only way to sustain
life. Dr. Xiao developed and is performing a novel procedure in
China that connects a functioning, healthy lumbar spinal nerve root
to the sacral nerve that controls the bladder. The end result is
the creation of a new reflex where the bladder can be emptied by
scratching or stimulating the skin supplied by that spinal nerve
root. He has reported that in 92 SCI patients, 88% regained bladder
control within one year after the nerve rerouting surgery and in
110 children with spina bifida, reported success in 87% at one
year. However, in China rigorous follow up is challenging,
therefore much is still unknown about the neurorecovery post
surgery, complications and results occurring in the first year in
particular, and the potential role that central nervous system
remodeling may play in achieving successful outcomes. At Beaumont,
a pilot study is underway on 9 spina bifida subjects, however no
other center in the US is currently studying this technique. Our
preliminary data are very promising, and with 9 subjects now 12
months post procedure, 7/9 subjects are voiding either voluntarily
or by stimulating the new reflex mechanism. This project aims to
expand upon our pilot experience to conduct a larger and more
rigorous study to establish the safety and effectiveness of the
proposed somatic-autonomic reflex pathway procedure in gaining
bladder and bowel control in patients with spina bifida.
Additionally, we will systemically evaluate and optimize frequency
and location for excitation of the new somatic-autonomic reflex arc
to a) gain more insight into the neurorecovery associated with
nerve rerouting, and b) scientifically and systematically determine
the ideal stimulation parameters to achieve best voiding results
and make the somatic-autonomic reflex pathway rerouting most useful
for the patients. Achieving the aims outlined in this proposal will
help firmly establish the procedure as safe and effective, and
revolutionize the treatment of bladder and bowel dysfunction in
patients with spina bifida. PUBLIC HEALTH RELEVANCE: Spina Bifida,
a congenital defect of the spinal cord, causes nerve damage
resulting in bowel, bladder and sexual dysfunction. Dr. Xiao, in
China, developed a new procedure to rewire the nerves affecting the
bladder, and this project aims to scientifically establish the
safety and effectiveness of the surgical procedure. |
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Health Relevance Statement: |
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Principal Investigator/Program Director (Last, First,
Middle): Peters, Kenneth M. Project Narative: Spina Bifida, a
congenital defect of the spinal cord, causes nerve damage resulting
in bowel, bladder and sexual dysfunction. Dr. Xiao, in China,
developed a new procedure to rewire the nerves affecting the
bladder, and this project aims to scientifically establish the
safety and effectiveness of the surgical procedure. |
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加载中…
(2010-09-27 17:08:07) 