Monday, April 09, 2007

Hospital Tests New Surgery

Baumont procedure could improve bladder control

What does it take to import a medical procedure from China to Detroit?

In a reversal of the globalization seen in many industries, doctors from Beaumont Hospital in Royal Oak this week began a pilot study, under the watchful eye of the Chinese surgeon who developed the operation, that could help millions of Americans regain bladder control after spinal cord injuries and spina bifida, one of the most common and disabling birth defects.

Beaumont's team will perform the procedure on seven children and one adult with spina bifida, all but one of whom are from outside Michigan, evidence of the far-reaching appeal of the technique.

Then the team will wait one to two years to see if new nerve paths created in the surgery restore continence in the patients. Only then would the study be resumed.

Spinal cord patients, some 260,000 in the United States alone, and another 70,000 Americans who live with spina bifida await results.

The surgery creates a neural connection that signals the bladder to empty when a person touches the thigh, said Dr. Chuan-Gao Xiao, who practices at Huazhong University of Science & Technology in Wuhan, China.

If successful, the operation might save billions of dollars in lifelong costs related to incontinence and infection.

"We have over 200 children from all over the country who want this done and we have no other money right now," said Dr. Kenneth Peters of Beaumont's urology team and head of the team that traveled to China to learn the surgery. Applications poured in after the first three surgeries were performed at Beaumont in December on two people with spinal cord injuries and one with spina bifida. Without federal or private research grants that pay for many studies of investigational procedures, Beaumont had to find a donor.

J. Peter and Florine Ministrelli of West Bloomfield, who have given $15 million to the hospital for urology and cardiology research, will pay for this week's operations, which are estimated at $40,000 each.

Jessica Palmer, 8, who lives in Downingtown, Pa., underwent the procedure Tuesday. She is a medical pioneer already. When her mother was pregnant, doctors performed in-utero surgery to try to correct her spina bifida after it was diagnosed by an ultrasound test.

The Palmers say the pre-birth surgery did some good; Jessica walks with braces and is a bright second-grader who loves to draw and ride horses. "We were told she'd never walk," said her mother, Carol, a registered nurse.

"She's a tough little girl; she's been through so much already," said John Palmer, Jessica's father. The family considered going to China for the surgery. Though some risks are associated with it, "there's no guarantee with anything," Carol Palmer said.

There are no good estimates on the cost of incontinence in patients with spina bifida or spinal cord injury. The United States spends $16.3 billion a year on costs for urinary incontinence, according to a 2001 analysis in Obstetrics and Gynecology, a leading journal.

After several years of operating on animals, Xiao began performing the operation on humans with spinal cord injuries in 1995. He began doing the surgery on spina bifida patients in 2000, he said. In all, he's performed 340 surgeries, and says 80% have achieved satisfactory bladder control and no longer must use catheters. Some also have achieved bowel improvements, he said.

Children show regenerated nerves the fastest, he said. Those with prior bladder augmentations are not candidates for the operation.

Early on, two spina bifida patients developed muscular weakness and foot drop after the surgery, but changes in the technique have "dramatically decreased the incidence of this complication," Xiao said.

While he was doing a fellowship in Norfolk, Va., some of his research was underwritten by the Paralyzed Veterans of America and the National Institutes of Health, he said.

The surgery, called a hemi-laminectomy, is performed under general anesthesia and takes about two hours.

Doctors make about a four-inch incision near the lower part of the spine and open the dura, the protective sheath around the spinal cord, exposing the network of nerve roots that feed it. They find what they call a donor nerve in the leg, and measure its nerve conductivity with electrical tests.

The nerve then is split, with a portion still attached to the spinal cord, and routed to the bladder. There, another so-called recipient nerve from the spinal cord is spliced, again leaving a portion attached to the spinal cord, and the two ends are sewn together with a single stitch. It creates a new circuit that bypasses the brain, Peters said. "You are rerouting the nerve, using the nerve that moves the leg to feed nerves to the bladder."

Xiao compared the operation to fixing an electrical problem. Sometimes the lightbulb needs to be replaced; other times, the circuitry is the culprit, he said.

"What we are doing is putting the electricity back," he said.

BY PATRICIA ANSTETT

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