Neural Reconstruction Methods of Restoring Bladder Function: A Critical Review

During the last century, diverse studies have focused on the development of surgical strategies for restoration of function of a decentralized bladder after spinal cord or spinal root injury via repair of the original roots or by transferring in new axon sources. These techniques have included end-to-end sacral root repairs, transfer of roots from other segments to sacral roots, transfer of intercostal nerves to sacral roots, transfer of various somatic nerves to the pelvic or pudendal nerve, direct neurotization of the detrusor muscle, and creation of an artificial "skin-CNS-bladder" reflex pathway. We have comprehensively reviewed these surgical techniques, the strengths and limitations of each, and have discussed the most appropriate patient population for each procedure. Our purpose is to critically assess the potential efficacy of nerve transfer techniques as options for restoring urinary function after bladder decentralization.