THE LATISSIMUS-DORSI MUSCLE FOR DETRUSOR ASSISTANCE - FUNCTIONAL RECOVERY AFTER NERVE DIVISION AND REPAIR

The treatment of choice for bladder atonia is clean intermittent cathe terization. To eliminate the catheter-related morbidity and increase t he quality of life for patients with an atonic bladder, the restoratio n of bladder contractility would be desirable. Based on our hypothesis that skeletal muscle might augment bladder contractility, we designed the present study to examine the ability of the latissimus dorsi musc le in situ to empty a bladder-like reservoir and to regenerate after d ivision and repair of the supplying motor nerve. In 4 dogs, the left l atissimus dorsi muscle was dissected, mobilized and wrapped around a b ladder substitute (100-ml. silicone reservoir). Stimulation of the tho racodorsal nerve resulted in the evacuation of 63.8 +/- 6.2% of the re servoir's volume and a maximum pressure of 109.5 +/- 18.6 cm. H2O. Fou r months later, the thoracodorsal nerve supplying motor control to the muscle was transected and microsurgically reanastomosed. Using transc utaneous stimulation, we recorded the pressure generation and resultin g evacuation at regular intervals for 8 months (that is, 12 months aft er the initial surgery). At the end of this period, the pressure was 7 9.3 +/- 12.1 cm. H2O (72.4% of the initial value), expelling 48.3 +/- 6.7% of total volume. This long-term study demonstrates: (1) the abili ty of the transposed latissimus dorsi muscle to evacuate a bladder-lik e reservoir; and (2) the regenerative potential of muscle and nerve af ter nerve transsection and repair. Use of skeletal muscle, which can b e readily stimulated may serve to facilitate bladder emptying and prov ide a treatment alternative to intermit tent catheterization in the fu ture.