SKIN-CNS-BLADDER REFLEX ARC FOR MICTURITION AFTER SCI
Chuan-guo Xiao
New York University School Of Medicine New York, Ny 10016
Grant 5R01DK053063-05 from National Institute Of Diabetes And Digestive And Kidney Diseases IRG: ZRG1
Abstract: The neurological bladder caused by spinal cord injury (SCI) presents a significant medical and social problem. There is no satisfactory treatment yet. Supported by the Paralyzed Veterans of America and NIH, a new reflex pathway, "Skin-CNS-Bladder" for controlled micturition after SCI has been successfully established in rat, cat and canine models. Preliminary clinical application of 14 SCI patients also provided very promising results. The study proposed here is to transfer the Skin-CNS-Bladder reflex functions. The ventral root (VR) of a lumbar nerve (L5) below the spinal cord lesion will be anastomosed to the sacral VR (S2 and/or S3) which innervate the bladder, while leaving the intact L5 dorsal root (DR) as a started of micturition. After the axonal regeneration, controllable voiding would be initiated by scratching the L4 dermatome. Effect of the new reflex pathway on bladder function will be evaluated by means of electrophysiology and urodynamics. Its effect on bowel and sexual functions will also be studied. The procedure may revolutionize the treatment of neurogenic bladder after SCI, It requires relatively minor surgery on 2 paralyzed nerves. It does not involve implantation of electrodes or other devices but provides unique voluntary control of bladder emptying. Scientifically, the study will further prove the new concept derived from the unique somatic-autonomic reflex that the impulses delivered from the efferent neurons of a somatic reflex arc may be transferred to initiate response of an autonomic effector. This new concept may be widely useful, not only for neurogenic bladder, but also for other problems caused by the spinal cord injury or diseases.
Keywords: electrophysiology, human therapy evaluation, neurogenic urinary bladder disorder, neuroregulation, neurosurgery, somatic reflex, spinal cord injury, urination, central nervous system, clinical trial, functional ability, outcomes research, quality of life, skin, urinary electronic stimulator, clinical research, human subject
Project start date: 1999-09-30
Project end date: 2007-12-31
5R01DK053063-05 (2004): $642796
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SKIN-CNS-BLADDER REFLEX ARC FOR MICTURITION AFTER SCI
Chuan-guo Xiao
New York University School Of Medicine New York, Ny 10016
Grant 5R01DK053063-04 from National Institute Of Diabetes And Digestive And Kidney Diseases IRG: ZRG1
Abstract: The neurological bladder caused by spinal cord injury (SCI) presents a significant medical and social problem. There is no satisfactory treatment yet. Supported by the Paralyzed Veterans of America and NIH, a new reflex pathway, "Skin-CNS-Bladder" for controlled micturition after SCI has been successfully established in rat, cat and canine models. Preliminary clinical application of 14 SCI patients also provided very promising results. The study proposed here is to transfer the Skin-CNS-Bladder reflex functions. The ventral root (VR) of a lumbar nerve (L5) below the spinal cord lesion will be anastomosed to the sacral VR (S2 and/or S3) which innervate the bladder, while leaving the intact L5 dorsal root (DR) as a started of micturition. After the axonal regeneration, controllable voiding would be initiated by scratching the L4 dermatome. Effect of the new reflex pathway on bladder function will be evaluated by means of electrophysiology and urodynamics. Its effect on bowel and sexual functions will also be studied. The procedure may revolutionize the treatment of neurogenic bladder after SCI, It requires relatively minor surgery on 2 paralyzed nerves. It does not involve implantation of electrodes or other devices but provides unique voluntary control of bladder emptying. Scientifically, the study will further prove the new concept derived from the unique somatic-autonomic reflex that the impulses delivered from the efferent neurons of a somatic reflex arc may be transferred to initiate response of an autonomic effector. This new concept may be widely useful, not only for neurogenic bladder, but also for other problems caused by the spinal cord injury or diseases.
Keywords: electrophysiology, human therapy evaluation, neurogenic urinary bladder disorder, neuroregulation, neurosurgery, somatic reflex, spinal cord injury, urination, central nervous system, clinical trial, functional ability, outcomes research, quality of life, skin, urinary electronic stimulator, clinical research, human subject
Project start date: 1999-09-30
Project end date: 2004-12-31
5R01DK053063-04 (2003): $625059
Grants awarded to Chuan-guo Xiao
SKIN-CNS-BLADDER REFLEX ARC FOR MICTURITION AFTER SCI
Chuan-guo Xiao
Long Island College Hosp (brooklyn)
340 Henry St
new York, Ny 11201
Grant 1R01DK053063-01A2 from National Institute Of Diabetes And Digestive And Kidney Diseases IRG: ZRG1
Abstract: The neurological bladder caused by spinal cord injury (SCI) presents a significant medical and social problem. There is no satisfactory treatment yet. Supported by the Paralyzed Veterans of America and NIH, a new reflex pathway, "Skin-CNS-Bladder" for controlled micturition after SCI has been successfully established in rat, cat and canine models. Preliminary clinical application of 14 SCI patients also provided very promising results. The study proposed here is to transfer the Skin-CNS-Bladder reflex functions. The ventral root (VR) of a lumbar nerve (L5) below the spinal cord lesion will be anastomosed to the sacral VR (S2 and/or S3) which innervate the bladder, while leaving the intact L5 dorsal root (DR) as a started of micturition. After the axonal regeneration, controllable voiding would be initiated by scratching the L4 dermatome. Effect of the new reflex pathway on bladder function will be evaluated by means of electrophysiology and urodynamics. Its effect on bowel and sexual functions will also be studied. The procedure may revolutionize the treatment of neurogenic bladder after SCI, It requires relatively minor surgery on 2 paralyzed nerves. It does not involve implantation of electrodes or other devices but provides unique voluntary control of bladder emptying. Scientifically, the study will further prove the new concept derived from the unique somatic-autonomic reflex that the impulses delivered from the efferent neurons of a somatic reflex arc may be transferred to initiate response of an autonomic effector. This new concept may be widely useful, not only for neurogenic bladder, but also for other problems caused by the spinal cord injury or diseases
Keywords: electrophysiology, human therapy evaluation, neurogenic urinary bladder disorder, neuroregulation, neurosurgery, somatic reflex, spinal cord injury, urination central nervous system, clinical trial, functional ability, outcomes research, quality of life, skin, urinary electronic stimulator clinical research, human subject
Project start date: 1999-09-30
Project end date: 2000-02-14
1R01DK053063-01A2 (1999): $549964
SKIN-CNS-BLADDER REFLEX PATHWAY FOR MICTURITION
Chuan-guo Xiao
Long Island College Hosp (brooklyn)
340 Henry St
new York, Ny 11201
Grant 1R01DK044877-01A2 from National Institute Of Diabetes And Digestive And Kidney Diseases IRG: SAT
Abstract: The neurogenic bladder caused by spinal cord injury presents a significant medical and social problem. Aside from the poor quality of life because of the uncontrollable bladder, two thirds of the victims will die of the chronic urinary infections and renal failure. There is no satisfactory treatment. The research proposed here is to try to restore the controllable micturition by establishing a new reflex pathway "Skin-CNS-Bladder" in the canine model. The venture root(VR) of a lumbar nerve(L7) will be anastomosed extradurally to the sacral VR(s) which innervate the bladder, while leaving the intact L7 dorsal root(DR) as a starter of micturition. After the axonal regeneration, controllable voiding would be initiated by stimulation of the L7 nerve which should have only sensory functions (by scratching the L7 related skin in the patients). The new pathway will be tested by using techniques of horseradish peroxidase (HRP) neural tracing and electrophysiology. Bladder urodynamics and external urethral sphincter EMG will be examined to evaluate the function. Possible ultramicro-structural changes following the somatic axon regeneration in preganglionic synaptic terminals, pelvic ganglionic neurons and bladder detrusor muscle will be examined at light and/or electron microscopic level. The "Skin-CNS-Bladder" pathway may greatly improve the treatment of the neurogenic bladder. It is interesting and theoretically important to clarify if and how somatic axons can regenerate into an autonomic nerve and reinnervate the effector, and how the two nervous systems co-operate in the "Skin-CNS-Bladder" reflex. This may result in a new concept and lead to a new research field in neuroscience. The new concept, i.e. the impulses delivered from the efferent neurons of a somatic arc may be transferred to initiate response of an autonomic effector, may be widely useful, not only for neurogenic bladder, but also for other problems caused by the spinal cord injury or diseases
Keywords: biological model, dog, model design /development, neural initiation, neurogenic urinary bladder disorder, spinal reflex autonomic reflex, axon, nervous system regeneration, skin, spinal cord surgery, synapse, urination electron microscopy, electrophysiology
Project start date: 1994-02-01
Project end date: 1996-11-30
1R01DK044877-01A2 (1994): $149388
5R01DK044877-02 (1995): $109508
5R01DK044877-03 (1996): $98171
Dr. Yves Homsy serves as Clinical Professor of Surgery (Urology) and Pediatrics at the University of South Florida, and practices as a Pediatric Urologist at All Children's Hospital.
Dr. Luis Felipe Rodriguez practices Pediatric Neurosurgery at All Children's Hospital and the University of South Florida. He is Assistant Professor of Neurosurgery in the Department of Neurological Surgery and Rehabilitation, University of South Florida School of Medicine.
After graduating from Medical School at Northwestern University Medical School in Chicago, Dr. Tuite completed his general surgery internship at Northwestern University and his Neurosurgery Residency at University of Michigan. After serving a year as Chief Resident at the University of Michigan, Dr. Tuite took a Pediatric Neurosurgical and Complex Spinal Fellowship at Great Ormond Street Hospital for Children in London, England. Dr. Tuite completed his medical training with a Pediatric Neurosurgery Fellowship at Texas Children's Hospital in Houston.
