Bladder Re-Innervation—State of the Art

Abstract

Neurogenic bladder used to have no cure. An old idea of bladder re-innervation resurfaced with this new concept and promising results. This article reviews the current status of the clinical studies on bladder re-innervation with a somatic-autonomic reflex arc (Xiao procedure). A total of 2840 patients to date with spinal cord injury or spina bifida underwent the Xiao procedure for neurogenic bladder in three major medical centers in China. The effective rates have been stable in the range of 67∼85 %. While four centers in USA carried out clinical trials of the Xiao procedure, three reported positive results similar to the Chinese results, but one reported 100 % failure. Two centers in Denmark and Germany also reported negative responses of SCI patients to the Xiao procedure. By comparing the patient’s information in different countries and different centers, a few major facts affecting the results have been identified. These include overextension and fibrosis of detrusor muscle, as well as incorrect anticholinergic and CIC usage. A list of criteria has been suggested to maximize the effect of the Xiao procedure.