Clinical Study Of The Artificial Bladder Reflex Arc Established In Therapy Of Neurogenic Bladder After Spinal Cord Injury

China is a country with a large population, and also a large country withspinal cord injury. According to reports,50million of long-term survival ofpatients with spinal cord injuries in the United States,10,000new casesannually. No spinal cord injury accurate census figures, but according to theincidence of projections, China’s current total number of patients with spinalcord injury of about100people, and each year about50,000new patients withspinal cord injury. The most common cause of spinal cord injury causes weretraffic accidents, trauma, sports and violence. The most common site of spinalcord injury in the neck and thoracic junction. Combined injury is the mostcommon site of fractures of the head, upper limbs, torso, chest and abdominalorgan damage.Spinal cord injury-prone in young men, with an average30-year-old.Domestic and international data show that, after the stability of the spinal cordinjury, the treatment of bladder storage and voiding function, is the mainfactor affecting the patient’s life and the life of. Currently, urinarycomplications after spinal cord injury （Urinary retention, urinary incontinence,urinary tract infections, bladder pressures cause urine reflux, hydronephrosis,renal failure） in China is still kind of late death in patients with bit reasons.Bladder to urinate a sense of loss of contractile function after spinal cordinjury, bladder detrusor sustained spastic or flaccid state, is the main causecomplications occurred.Bladder function after spinal cord injury involves a multi-disciplinary,multi-disciplinary knowledge, existing treatment programs are also in thedevelopment stage, difficult to have an ideal treatment method used clinically.Objective:To study the clinical outcomes of re-establishment theartificial bladder reflex arc with the normal reflex pathway to restore functions of neurogenic bladder after spinal cord injury. Usually the patient’s ownfrequency of urination, urine output and residual urine volume, andpreoperative urodynamic study of the postoperative three different timeconvincing indicators extracted three aspects systematic evaluation ofstatistical dataclinical treatment of neurogenic bladder after spinal cord injuryrehabilitation efficacy reconstruction of artificial bladder reflex arc to provethe feasibility of the program is to improve the quality of life in patients withneurogenic bladder after spinal cord injury, reduce patient complications,reduce mortality in patients.Methods:The preoperative investigation catheter and connected to apressure measuring device.Reconstruction the artificial reflex arc wasperformed in36patients with complete spinal cord injury, including28patients （spastic bladder） with spinal cord injury above the conus medullarisby unilateral microanastomosis anterior roots of S₁（The Achilles Tendoncentral plane） or L3（Knee tendon central plane）to main bladder innervatingroots （S₂or S₃）. Find method of the nerve root: by electrical stimulation（parameters:20V,20Hz,10s） S₁, S₂, S₃nerve root before root observationpiezometers value, the pressure is the highest for the bladder major disposablenerve root （surgeryin most of the cut side of the S₂ventral root andcontralateral S₃ventral root）. Eight patients （atonic bladder） with conusmedullaris injury by unilateral microanastomosis of the T10/T11ventral root tomain bladder innervating ventral root with sural nerve （Nerve root lookingthe same way the spastic bladder）. Micturition function of34patients （2patients with spastic bladder died） were followed up and examined byurodynamic examination （rate of flooding of NS was25ml/s）postoperativelyat the6th,12th,18th month, evaluate function recovery of spastic bladder andflaccid bladder. Select three indexes （maximum cystometric capacity, volumeof residual, bladder compliance） of spastic bladder patients for assessingbladder functions with statistical analysis.Results: Line bladder function after spinal cord injury patients withneurogenic bladder reconstruction, operative time2to4h, an average of3.5h; blood loss of500to1000ml and average600ml. The wound healed, and nocase of infection. A case study was carried out on26spastic bladder patients.Three times sample collection of subjects’ maximum cystometric capacitywere conducted, pre-and post-operation respectively. It turned out that there isno significant difference （P>0.05） mutually; however it show a significantdifference with the pre-operative patients themselves （P<0.05）. The index ofvolume of residual and bladder compliance present a significant differencerespectively （P<0.05）. Another case study was conducted on8atonic bladderpatients with the same method as previously. The results show that there islittle change on maximum cystometric capacity（normal value400⁶00ml） asthe pre-operative patients themselves, with a value415⁵63ml. howevervolume of residual decrease from the pre-operation value428⁶05ml to thepost-operation value232～302ml; Pdet.max go up to the post-operation value67～89cmH2O from the pre-operation value0～13cmH2O. There is no onecase micturates caused by scratching abdomen skin in the two case studies.Conclusion:In addition to the death of two patients. The study showedthat using the normal reflex pathway to reconstruct artificial reflex arc totreatment of bladder functions is a feasible. Normal nerve reflex pathwayreconstruction artificial reflex arc significantly observed in patients withneurogenic bladder after spinal cord injury can reduce residual urine volume,improve the spastic bladder volume, reduce urinary tract infection in patientswith impaired renal function, and, ultimately,autonomy in patients withneurogenic bladder voiding provide a good treatment for the patientsthemselves, and lighten the burden for the family and the community.