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Nerve transfer for restoration of lower motor neuron-lesioned bladder, urethral and anal sphincter function. Part 4: Effectiveness of the motor reinnervation
Tiwari, Ekta Porreca, Danielle S. Braverman, Alan S. Holt-Bright, Lewis Frara, Nagat A. Brown, Justin M. Johnston, Benjamin R. Bazarek, Stanley F. Hilliard, Brendan A. Mazzei, Michael
Tiwari, Ekta
Porreca, Danielle S.
Braverman, Alan S.
Holt-Bright, Lewis
Frara, Nagat A.
Brown, Justin M.
Johnston, Benjamin R.
Bazarek, Stanley F.
Hilliard, Brendan A.
Mazzei, Michael
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Journal article
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2024-03-18
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https://doi.org/10.1152/ajpregu.00248.2023
Abstract
In pilot work, we showed that somatic nerve transfers can restore motor function in long-term decentralized dogs. We continue to explore the effectiveness of motor reinnervation in 30 female dogs. After anesthesia, 12 underwent bilateral transection of coccygeal and sacral (S) spinal roots, dorsal roots of lumbar (L)7, and hypogastric nerves. Twelve months postdecentralization, eight underwent transfer of obturator nerve branches to pelvic nerve vesical branches, and sciatic nerve branches to pudendal nerves, followed by 10 mo recovery (ObNT-ScNT Reinn). The remaining four were euthanized 18 mo postdecentralization (Decentralized). Results were compared with 18 Controls. Squat-and-void postures were tracked during awake cystometry. None showed squat-and-void postures during the decentralization phase. Seven of eight ObNT-ScNT Reinn began showing such postures by 6 mo postreinnervation; one showed a return of defecation postures. Retrograde dyes were injected into the bladder and urethra 3 wk before euthanasia, at which point, roots and transferred nerves were electrically stimulated to evaluate motor function. Upon L2-L6 root stimulation, five of eight ObNT-ScNT Reinn showed elevated detrusor pressure and four showed elevated urethral pressure, compared with L7-S3 root stimulation. After stimulation of sciatic-to-pudendal transferred nerves, three of eight ObNT-ScNT Reinn showed elevated urethral pressure; all showed elevated anal sphincter pressure. Retrogradely labeled neurons were observed in L2-L6 ventral horns (in laminae VI, VIII, and IX) of ObNT-ScNT Reinn versus Controls in which labeled neurons were observed in L7-S3 ventral horns (in lamina VII). This data supports the use of nerve transfer techniques for the restoration of bladder function.
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Nerve transfer for restoration of lower motor neuron-lesioned bladder, urethral and anal sphincter function. Part 4: Effectiveness of the motor reinnervation Ekta Tiwari, Danielle S. Porreca, Alan S. Braverman, Lewis Holt-Bright, Nagat A. Frara, Justin M. Brown, Benjamin R. Johnston, Stanley F. Bazarek, Brendan A. Hilliard, Michael Mazzei, Michel A. Pontari, Daohai Yu, Michael R. Ruggieri Sr, Mary F. Barbe. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 2024 326:6, R528-R551
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American Physiological Society
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American Journal of Physiology, Vol. 326, Iss. 6
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