Sciatic Nerve to Pudendal Nerve Transfer: Anatomical Feasibility for a New Proposed Technique

Abstract

Aim Restoration of bladder and bowel continence after pudendal nerve anastomosis has been shown successfully in animal models and may be applicable in humans. Aim of this cadaveric study was to assess feasibility of pudendal nerve neurotization using motor fascicles from sciatic nerve.

Methods Pudendal and sciatic nerves were exposed via gluteal approach in 5 human cadavers (10 sites). Size of pudendal and sciatic nerves and the distance between two nerves was measured.

Results There were four male and one female cadavers. Mean age was 62 (range, 50–70) years. Mean pudendal nerve diameter was 2.94 mm (right side) and 2.82 mm (left side). Mean sciatic nerve diameter was 11.2 mm (right side) and 14.2 mm (left side). The distance between two nerves was 23.4 mm on both sides.

Conclusion Transfer of the motor fascicles from sciatic nerve to pudendal nerve to restore the bladder and bowel continence is feasible.

Keywords

sciatic nerve - pudendal nerve - neurotization - incontinence - bladder - spinal cord injury

• References

• 1 Yoshimura N, de Groat WC. Neural control of the lower urinary tract. Int J Urol 1997; 4 (02) 111-125
• 2 Wilson L, Brown JS, Shin GP, Luc KO, Subak LL. Annual direct cost of urinary incontinence. Obstet Gynecol 2001; 98 (03) 398-406
• 3 O'Bichere A, Green C, Phillips RK. New, simple approach for maximal pudendal nerve exposure: anomalies and prospects for functional reconstruction. Dis Colon Rectum 2000; 43 (07) 956-960
• 4 Kao JT, Burton D, Comstock C, McClellan RT, Carragee E. Pudendal nerve palsy after femoral intramedullary nailing. J Orthop Trauma 1993; 7 (01) 58-63
• 5 Shetty SD, Kirkemo AK. Bilateral bone anchor vaginal vault suspension: an initial report of a new technique. Tech Urol 1997; 3 (01) 1-5
• 6 Gillitzer R, Hampel C, Wiesner C, Pahernik S, Melchior SW, Thüroff JW. Pudendal nerve branch injury during radical perineal prostatectomy. Urology 2006; 67 (02) 423.e1-423.e3
• 7 Christianson JA, Liang R, Ustinova EE, Davis BM, Fraser MO, Pezzone MA. Convergence of bladder and colon sensory innervation occurs at the primary afferent level. Pain 2007; 128 (03) 235-243
• 8 Heidkamp MC, Leong FC, Brubaker L, Russell B. Pudendal denervation affects the structure and function of the striated, urethral sphincter in female rats. Int Urogynecol J Pelvic Floor Dysfunct 1998; 9 (02) 88-93
• 9 Kreder KJ, Austin JC. Treatment of stress urinary incontinence in women with urethral hypermobility and intrinsic sphincter deficiency. J Urol 1996; 156 (06) 1995-1998
• 10 Cammu H, Van Nylen M, Amy JJ. A 10-year follow-up after Kegel pelvic floor muscle exercises for genuine stress incontinence. BJU Int 2000; 85 (06) 655-658
• 11 Hassouna ME, Ghoniem GM. Long-term outcome and quality of life after modified pubovaginal sling for intrinsic sphincteric deficiency. Urology 1999; 53 (02) 287-291
• 12 Winters JC, Chiverton A, Scarpero HM, Prats Jr LJ. Collagen injection therapy in elderly women: long-term results and patient satisfaction. Urology 2000; 55 (06) 856-861
• 13 Brindley GS. The first 500 patients with sacral anterior root stimulator implants: general description. Paraplegia 1994; 32 (12) 795-805
• 14 Xiao CG. Reinnervation for neurogenic bladder: historic review and introduction of a somatic-autonomic reflex pathway procedure for patients with spinal cord injury or spina bifida. Eur Urol 2006; 49 (01) 22-28 discussion 28–29
• 15 Ruggieri MR, Braverman AS, D'Andrea L, McCarthy J, Barbe MF. Functional reinnervation of the canine bladder after spinal root transection and immediate somatic nerve transfer. J Neurotrauma 2008; 25 (03) 214-224
• 16 Barbe MF, Ruggieri Sr MR. Innervation of parasympathetic postganglionic neurons and bladder detrusor muscle directly after sacral root transection and repair using nerve transfer. Neurourol Urodyn 2011; 30 (04) 599-605
• 17 Tuite GF, Storrs BB, Homsy YL. et al. Attempted bladder reinnervation and creation of a scratch reflex for bladder emptying through a somatic-to-autonomic intradural anastomosis. J Neurosurg Pediatr 2013; 12 (01) 80-86
• 18 Tachibana E, Saito K, Fukuta K, Yoshida J. Evaluation of the healing process after dural reconstruction achieved using a free fascial graft. J Neurosurg 2002; 96 (02) 280-286
• 19 Barbe MF, Brown JM, Pontari MA, Dean GE, Braverman AS, Ruggieri MR. Feasibility of a femoral nerve motor branch for transfer to the pudendal nerve for restoring continence: a cadaveric study. J Neurosurg Spine 2011; 15 (05) 526-531
• 20 Brown JM, Barbe MF, Albo ME, Lai HH, Ruggieri Sr MR. Anatomical feasibility of performing intercostal and ilioinguinal nerve to pelvic nerve transfer: a possible technique to restore lower urinary tract innervation. J Neurosurg Spine 2012; 17 (04) 357-362
• 21 Brown JM, Barbe MF, Albo ME, Ruggieri Sr MR. Anatomical feasibility of performing a nerve transfer from the femoral branch to bilateral pelvic nerves in a cadaver: a potential method to restore bladder function following proximal spinal cord injury. J Neurosurg Spine 2013; 18 (06) 598-605
• 22 Mckinley JC. The intraneural plexus of fasciculi and fibers in the sciatic nerve. Arch Neurol Psychiatry 1921; 6: 317-399
• 23 Narakas AO. The surgical treatment of traumatic brachial plexus lesions. Int Surg 1980; 65 (06) 521-527