Free Innervated Latissimus Dorsi Muscle Flap for Bladder Atonia

The current treatment for bladder atonia is clean intermittent catheterization. A new surgical technique to restore detrusor function by transplantation of innervated latissimus dorsi muscle flap has been developed by Stenzl and Ninkovic. The authors presented their first and successful case with this new microneurovascular method. In a 52-year-old male patient with incomplete L4-L5 spinal-cord injury and bladder atonia, who had required intermittent catheterization for 7 years, was treated with latissimus dorsi detrusor mioplasty. Preoperative and follow-up evaluation included cistoscopy, urodynamic assessment, echotomograph,y and electromyography of the rectus muscle. The surgical procedure involved transfer of a free neurovascular latissimus dorsi muscle flap to the pelvis where it was anastomosed to the 12th intercostal motor nerve branch and deep inferior epigastric vessels. Four months postoperatively, the patient was able to void spontaneously with low post void residual volumes and 100% continence. The follow-up is 20 months, and he has definitively abandoned catheterization. Microneurovascular free transfer of the latissimus dorsi muscle was a useful method to restore a deficient detrusor muscle in a patient previously dependent on catheterization, thus dramatically improving his quality of life.