de Groat, some of the children gained bladder sensory function. In his opinion, the major adverse effect was partial loss of L4–L5 motor function on one side. Occurrence rate of partial loss of the left L4 or L5 motor function after surgery, the only complication for 25% of the first 20 cases, has been dramatically reduced to 5%, by Xiao and coworkers, by using only half of the lumbar Inhibitors,research,lifescience,medical ventral root. Dr. de Groat summarized that the effects of bladder nerve rerouting in animal experiments have been confirmed

in clinical studies in patients with neurogenic storage and voiding symptoms. One of the major criticisms that can be raised about this procedure is that most of the clinical studies have been performed by a single research group in China. So, in agreement with Dr. de Groat’s remarks, more detailed urodynamic and neurologic studies with long-term follow-up are needed. New data have been added to the existing evidence and the first series of spina bifida children treated Inhibitors,research,lifescience,medical in the United States has been completed at the William Beaumont Hospital in Michigan. Dr. Kenneth Peters and associates are advancing the research with an NIH-sponsored study. In the final part of the presentation, Dr. de Groat reviewed possible directions for future studies. The emergence of bladder sensations after rerouting motor nerves to the bladder Inhibitors,research,lifescience,medical is difficult

to explain and may reflect plasticity in central neural pathways. This supposition is based on the detection of a similar mechanism of circuitry reorganization

Inhibitors,research,lifescience,medical in the sensorimotor cerebral cortex with brainimaging techniques after rerouting of nerves to striated muscles. Another unexpected result is the conversion of dyssynergic voiding to synergic voiding after unilateral nerve rerouting because the normal innervation of Inhibitors,research,lifescience,medical the lower urinary tract is intact on the contralateral side of the spinal cord and should continue to induce dyssynergia. Partial denervation of the sphincter after unilateral transection of the sacral roots may contribute to a reduction in kinase inhibitor Dasatinib dyssynergia, but plasticity in spinal pathways may also be an important factor. Dr. de Groat concluded that Drug_discovery bladder SKI 606 reinnervation is a promising area for research but many questions remain. Pudendal Neurostimulation as an Alternative to Sacral Nerve Stimulation Dr. Kenneth Peters4 and associates from the William Beaumont Hospital (Royal Oak, MI) reported the use of chronic pudendal neurostimulation (PNS) as an alternative form of treatment for patients with voiding dysfunction, particularly in those who fail to respond to sacral stimulation. Dr. Peters explained that they began offering PNS to patients who had failed sacral stimulation as well as for other difficult-to-treat patients. These patients represented some of the most complex patients in Dr. Peters’ practice. For the majority of these patients, PNS represented a last resort for managing symptoms and improving quality of life.