ARTEFICIAL SOMATO-CNS-AUTONOMIC MICTURITION REFLEX – EXPERIMENTAL VERIFICATION

Czech version

Authors: Pavel Zerhau ¹; Zdeněk Mackerle ²; Matěj Husár ¹; Daniela Sochůrková ²; Eva Brichtová ²; Eduard Göpfert ³; Martin Faldyna ³
Authors‘ workplace: Urologické oddělení KDCHOT FN a LF MU Brno ¹; Neurochirurgická klinika FN u sv. Anny a LF MU Brno ²; Výzkumný ústav veterinárního lékařství Brno ³
Published in: Ces Urol 2016; 20(2): 123-134
Category: Original Articles

Overview

Major statement:
Results of experimental creation of somato-CNS-autonomic reflex and verification of its influence on lower urinary tract function in rabbits. Specifically the possibility of induction of the arteficial micturition reflex, applicable in patients with neurogenic bladder.

Purpose:
Intradural somato-CNS-autonomic anastomosis remains an insufficiently verified neurogenic bladder treatment method. Specifically, possible detrusor–sphincter synergy during artificial stimulation is unclear. The aim of the study is the assessment of rabbits’ lower urinary tract symptoms after this reflex arc’s creation.

Materials and Methods:
During 2012–2015, 37 male rabbits underwent laminectomy. Under electromyographic and cystometric controls ventral spinal roots leading to suitable musculocutaneous segments of the left hind leg (donor, L₅–S₁) and detrusor muscle (recipient, S₂–S₃) were located. After their resection, intradural anastomosis of donor root to the recipient distal root stub was performed. After 3–16 months the artificial reflex arc’s function was examined in 17 rabbits. Donor skin segments and spinal root above the anastomosis were stimulated. Detrusor EMG response, intravesical pressure and sphincter response were monitored.

Results:
Electromyography confirmed detrusor and sphincter response to peripheral skin stimulation in 8 (47 %) and 5 (29 %) cases. Five (29 %) animals displayed elevated intravesical pressure up to 15 cm H₂O. Root stimulation induced detrusor and sphincter EMG response in 9 (53 %) and 7 (41 %) rabbits, respectively, and 4 (24 %) animals displayed increased P_ves up to 15 cm H₂O. Micturition was not induced in any animals. With confirmed detrusor contraction, external sphincter activity was never inhibited.

Conclusion:
Experimental creation of the somato- CNS-autonomic reflex arc is technically feasible. Reflex activity of this artificial arc is however detectable almost exclusively electrophysiologically. At the same time, the detection is possible only in a few cases. Induction of micturition reflex is not possible to initiate.

Key words:
Detrusor, intradural root anastomosis, neurogenic bladder.

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