A Clinical Application Of Bilateral Sacral Ventral Roots Crossing-over Anastomosis In Spastic Bladder After Spinal Cord Injury

Objective To discuss the clinical application of simple bladder capacity and pressure measurement in patients with complete spinal cord injury,in order to provide the evidence for the evaluation of bladder rehabilitation, anastomosing the bilateral sacral ventral roots intradurally. Explore the therapeutic effect established by anastomosing the bilateral sacral ventral roots intradurally for the spastic bladder in patients after spinal cord injuries.Methods Thirty-three patiens with bladder dysfunction were selected to follow-up and measured by the device,introduced to selected the treatment of bladder rehabilitation.Bilateral sacral anterior roots in 8 patients were severed intradurally and then anastomosed to treat the spastic bladder after spinal cord injuries,utilizing the intact somatic reflex(achilles tendon reflex) blow spinal cord lesions. The pre-operation and post-operation changes of simple bladder capacity-pressure measurement data in different times were recorded and compared.Results There were 4 cases of security capacity bladder , which pressure≦40cmH2O,capacity≧350ml ; 29 cases of small bladder (pressure≧40cmH2O,capacity≦350ml)among 33 SCI patients;According to the measurement,using different treatments of bladder rehabilitation,the urineary tract infection were decreased, compared with that before the treatment.The condition of bladder was poor without the treatment.The spasticity of urinary bladder was much relieved,the storage and evacuation function of the bladder improved significantly after operation in all cases. It was found that the patients were free from incontinence, with clean intermittent catheterization frequency of 4-6/d, and theurinary capacity varied from 200ml to 400ml each time on 2nd week. The bladder capacity and bladder compliance were significantly improved post-operation(P<0.05).For the bladder safe capacity,there were no clinical significance among the post- operation groups,when the bladder capacity was measured by the simple bladder capacity-pressure device at the 1st week,1st month,3th month of post-operation.After 3-19 months following-up investigation,the bladder function became normal or nearly normal.Conclusion The bladder capacity and pressure could be measured by the device,which could guide the treatments of the bladder rehabilitation,locate the roots in the surgery,improve the ability to control urination. It is suitable for carrying out in the grass-roots hospital and at home. Bilateral sacral anterior roots anastomosis is a good and effective method to treat spastic bladder after spinal cord injury.