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Motor Nerve Transfer for Voluntary Physiological Voiding: Scientific Foundations, Historical Review, and Case Report
Justin M Brown1, Elise De2, Benjamin R Johnston3
1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston , Massachusetts , USA.
Neurosurgery
|May 21, 2025
Summary
Somatic motor nerves were surgically transferred to reinnervate the bladder, restoring detrusor activation for functional voiding. This novel nerve transfer procedure demonstrated successful bladder reinnervation and volitional control in a patient with sacral nerve damage.
Area of Science:
- Neurosurgery
- Urology
- Regenerative Medicine
Background:
- Sacral nerve damage can lead to loss of bladder function.
- Surgical intervention is explored to restore bladder control after nerve injury.
Purpose of the Study:
- To report the surgical transfer of a somatic motor nerve to an autonomic target nerve.
- To recover detrusor activation for functional voiding.
- To detail the procedure and its 2-year clinical outcomes.
Main Methods:
- A patient with bladder dysfunction due to sacral nerve root resection underwent bilateral nerve transfers.
- A portion of the obturator nerve was used to reinnervate the bladder via the inferior hypogastric plexus.
- Functional and neurophysiological assessments were conducted over 2 years.
Main Results:
- Bladder fullness sensation returned at 6 months post-transfer.
- Volitional bladder contractions, confirmed by urodynamic studies, were achieved at 12 months.
- Urinary flow was achieved through thigh adduction and squatting, activating the obturator nerve.
Conclusions:
- This novel nerve transfer successfully redirected somatic axons to innervate the bladder for volitional voiding.
- The study provides a clinical proof of concept for nerve transfer-based bladder restoration.
- Further development of nerve transfer techniques is supported for patients with sacral denervation.
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