Bladder control 'within reach' afer spinal injury


Pediatric urologists have confirmed that environmental pollutants can impair male sexual development and fertility and that reinnervation of the bladder after spinal cord injury may be within reach.

Key Points

This year's AUA annual meeting brought both troubling and exciting news from pediatric urologists. Their work supports the idea that environmental pollutants can impair male sexual development and fertility.

Levels of organochloro-compounds (OCCs) are higher in boys with undescended testes than in boys with torsion or hernia. The high levels of OCC are also present in the serum of the boys as well as their mothers, suggesting an environmental influence.

Scientific studies are starting to confirm the association between abnormal sexual development and environmental toxins; among them, research from urologists at the Helen DeVoss Children's Hospital in Grand Rapids, MI.

These investigators tested serum samples and fat from boys undergoing surgery for undescended testes and serum from their mothers for OCCs, including polychlorinated biphenyls (PCBs) and major organochlorinated pesticides. The control group tested for the same compounds was made up of boys undergoing surgery for hernia or torsion. Compared with controls, the boys with undescended testes and their mothers had significantly higher levels of PCBs, supporting the theory that a maternal burden of endocrine-disrupting OCCs might cause undescended testis.

If you are able to find one testes in a patient with bilateral cryptorchid testes, the other is within "one anatomic step" from the other side. Also, the absence of adult dark spermatogonia and total germ cell counts less than 0.2 per tubule taken in infancy predict low sperm density when boys mature.

Pediatric urologists at Children's Hospital in Boston have determined that when the location of one undescended testis isn't apparent, the surgeon can find it in exactly the same anatomic position as the apparent contralateral one 62% of the time and just one anatomic "step"-less than 2 cm-away from that position 31% of the time. That finding should help surgeons identify the right surgical approach and may make those surgeries much more efficient.

Dr. Snyder and colleagues at Children's Hospital of Philadelphia found that if dark spermatogonia were absent or if the number of germ cells averaged less than 0.2 per tubule in infants undergoing orchidopexy, sperm density will be less than the World Health Organization's definition of oligospermia (ie, 20 million/mL) when the boys mature.

That also lends weight to the hypothesis that an endocrinopathy causes undescended testes.

"When we mechanically put the testis down into the scrotum, we're only treating part of the problem," Dr. Snyder explained. "We've been doing these biopsies for 20 years and treating kids who have a germ cell-depleted testes with gonadotropins, which has been well shown in Europe to make a difference in their future fertility."

A Michigan group tested the Xiao "skin-CNS-bladder" reflex, which may allow spina bifida or spinal cord injury patients to void at will by scratching a nerve in the leg.

"Reinnervation of the bladder is the Holy Grail for rehabilitation of someone who's had a neurologic injury to control of the bladder," Dr. Snyder said.

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