美国《泌尿学杂志》最近登了“肖氏手术”在美国首批9个病人试验的结果，
同时刊登了两篇负面的编辑评论。特别指出该结果与肖传国所说的在中国的
成功结果不符，缺乏对照组，结果无统计学意义、自相矛盾，某些病人出现的改
善可能是别的原因引起的，该手术应该只用于探索性研究，如果迅速用于临床会
有巨大的危险。

THE JOURNAL OF UROLOGY, Vol. 184, 702-708, August 2010

EDITORIAL COMMENTS

The authors present the first North American experience with lumbar to 
sacral nerve rerouting for patients with spina bifida. The results 
from this study and previous animal and clinical studies by Xiao 
clearly demonstrate that nerve rerouting produces a somatic-autonomic 
or cutaneous/bladder reflex with stimulation of the lower extremity 
dermatome.1 What is also clear is that the clinical benefit of the 
procedure is not at all similar to previous reports.
Although the authors did an excellent job of following the patients 
and characterizing their changes, the results are hard to validate 
without a control population going through the same rigorous 
surveillance regimen. In particular the improved bowel continence and 
minimal changes in bladder compliance may not be statistically 
significant. The fact that most patients were still on clean 
intermittent catheterization and none achieved complete urinary 
continence is troubling in light of the report of 87% success with 110 
children with spina bifida presented by Xiao.1 One has to wonder if 
most of these children are not voiding volitionally or using the newly 
developed cutaneous reflex, and how much reinnervation has a role in 
this surgery. Is it possible that unilateral denervation of the S3 
ventral motor nerve produced improved compliance and continence, as 
previously reported in numerous clinical series?2,3
I congratulate the authors for taking on this challenge. I hope this 
study leads to a rebirth or refocus regarding neurosurgical treatments 
of neuropathic bowel and bladder. I strongly agree with the authors 
that this procedure should remain on a research protocol only.

Eric A. Kurzrock
Pediatric Urology
U. C. Davis Children’s Hospital
Sacramento, California

One of the most curious findings is the discrepancy between urodynamic 
data and subjective voiding. One patient exhibited a decrease in 
capacity and an absence of reflex arc, and yet he subjectively 
reported improved bladder and bowel function! I could not help but 
speculate that his voiding after the procedure could simply be the 
bladder emptying via intra-abdominal pressure generation against an 
open bladder neck, given his preoperative stress incontinence. Xiao 
reported that more than 87% of 110 patients gained sensation and 
continence within 1 year (reference 7 in article). In comparison, the 
current patients undergoing the identical procedure with the help of 
Xiao himself only showed a modest improvement in objective urodynamic 
studies and subjective reporting. Unless the innovators provide a 
sound argument and data for the validity of the procedure, there is a 
great danger of its improper and rapid adaptation by patients and the 
medical community at large.

John M. Park
Department of Urology
University of Michigan Medical School
Ann Arbor, Michigan

REPLY BY AUTHORS

We agree this is a challenging study on many levels. The intent of 
publishing these 1-year data was to understand the potential 
complications associated with lumbar to sacral nerve rerouting, 
demonstrate that a cutaneous to bladder reflex is achievable and, 
given the nationwide interest in this procedure, reinforce the need to 
continue this rigorous research protocol until more is known about the 
risk-benefit profile. Hopefully our 36-month data will shed more light 
on the clinical usefulness of this innovative procedure.