Bladder Re-innervation – The Xiao Procedure
A lot of discussion has been centered on bladder reinnervation and the Xiao procedure. Basically, the procedure as an attempt at creating a “scratch” reflex for initiation of bowel emptying in patients. Creating this reflex is theorized to result in improved bladder and bowel functionality in those patients with neurogenic bladder and bowel dysfunction. Technically speaking, the Xiao procedure involves an intradural anastomosis that would result in the creation of a ” skin to central nervous system to bladder” chain reaction that would lead to an improvement in the patient’s bowel and bladder functions.
Eponyms and the Xiao Procedure
Eponyms commonly represent a twisting of the truth. On this point, the recent editorial regarding sacral nerve rerouting for the purpose of establishing a bladder reflex arc (The Xiao Procedure–What have we learned? J Urol 2016; 196: 1608-1609) is to be commended only, because of a call to action for seeking truth in science. The cautioning against reliance on hypotheses, unchecked confirmations and biases is also laudable and timely. Disappointingly however, the reviewer fell for the unscientific practice of using an eponym and, especially for this report, perpetuating the error of false credit.
An eponym attempts to honor a procedure or thing with a name and often, a person’s name. In that regard, an eponym implies not only that a completely spontaneous and novel idea or development was founded solely on the basis of an individual’s creative mind but, that the bestowed honor was worthy. Since most, if not all, “new” concepts are the result of an evolution and confluence of necessary conclusions, eponyms, especially when ascribed to a person, commonly represent an arbitrary weighting and approximation of originality so that misattribution of credit is frequent. Therefore, the assumptions and inaccuracy associated with eponyms have no legitimate place in a fact-based scientific world.
The Truth About Bladder Reinnervation
In 1983 I initiated a bladder reinnervation study at the Eastern Virginia Medical School (supported by NIH sponsorship) after believing that I had stumbled upon the seemingly novel concept of nerve crossover surgery (to re-establish the bladder reflex arc). However, before I was awarded a Master of Surgery diploma from the University of Otago in New Zealand in 1988 on the basis of my thesis “Urinary Bladder Reinnervation”, I discovered that Kilvington had already published his findings on the surgical treatment of certain paralyses years before in 1907.
Unfortunately, much of the urological literature is still burdened by appeals to emotion, beliefs and treatment philosophies while short on accuracy and objective factual science. Not only is there a great need to dispense with the use of trivial and pseudo-scientific eponyms in urology but, there is an even greater need for the pursuit of truth in urology. This need is especially great for the prostate cancer arena where the Gleason 6 prostate cancer is still labelled as a “cancer” although it clearly behaves as noncancerous and, its ill-founded and debilitating radical (robotic) prostatectomy “treatment” is marketed as FDA “approved” but never scientifically validated with evidence-based studies on even a single case of prostate cancer for safety or, effectiveness. Finally, without facts and truth there is only fake news and, its only purpose is to sway an opinion about something towards a certain ideological mindset with misleading or, false narratives. Such reporting is not only underhanded but, indefensible.
1. Kilvington, B.: An investigation on the regeneration of nerves with regard to surgical treatment of certain paralyses. Brit. Med. J., 1: 988-990, 1907
2. Vorstman, B., Schlossberg, S., Kass, L., Devine, C. J., Jr. Urinary bladder reinnervation. J. Urol., 136: 964-969, 1986
3. Vorstman, B., Schlossberg, S., Kass, L.: Investigations on urinary bladder reinnervation. Historical perspective and review. Urology, 30: 80-96, 1987