Obturator-to-pelvic nerve rerouting to restore bladder function after radical pelvic nerve injury

Damage to the pelvic nerve can occur at the time of a radical hysterectomy or during resection of a rectal cancer or sacrococcygeal teratoma and lead to a neurogenic bladder and an inability to volitionally void. We report on our experience with somatic-to-autonomic nerve regeneration by obturator-to-pelvic nerve rerouting and its results in terms of restoration of normal bladder function.

Eleven patients (2 male, 9 female; age range 4-58 years) with a neurogenic bladder following radical hysterectomy or resection of a sacrococcygeal teratoma underwent an obturator-to-pelvic nerve rerouting procedure. Urodynamic studies to evaluate bladder function and renal function studies were obtained preoperatively and up to 18 months post nerve rerouting and compared.

All patients could not void volitionally when enrolled. Nine of the 11 patients had restored voluntary voiding postoperatively. For the nine patients, pre and postoperative studies demonstrated remarkable improvement in bladder function with an increase in voiding volume from 0 to 285 ± 5.8 ml (P < 0.001), a decrease in residual urine volume from 240 ± 141.4 ml to 23 ± 18.6 ml (P < 0.01), an increase in detrusor contraction pressure (Pdet) from 3 ± 3.3 to 39 ± 6.5cmH₂O cmH2O (P < 0.001), return of urge sensation, a decrease in recurrent urinary tract infections from an average of 10 times/year preoperatively to almost none in patients who achieved voluntary voiding within 6 months postoperatively, and normalization in 3 of the 4 patients with elevated serum creatinine. The procedure was technically straightforward and safe with no complications reported. One patient showed no improvement, and one patient did not return for follow-up due to recurrence and metastasis of her cervical cancer.

Somatic-to-autonomic nerve regeneration by obturator-to-pelvic nerve rerouting can restore bladder sensory and motor function as well as voluntary voiding for patients with neurogenic bladder after sacrococcygeal teratoma resection or radical hysterectomy. (Chinese Clinical Trial Registry number: ChiCTR2100043618).