Hemiobturator Nerve-Innervated Latissimus Dorsi Muscle for Restoring Voluntary Voiding: Anatomic Study and Clinical Application.

This study presents a modified latissimus dorsi detrusor myoplasty technique using the hemiobturator nerve for neurogenic underactive bladder reconstruction. Anatomical studies ( n = 22 hemipelves) revealed that the diameters of the anterior (mean, 0.209 cm) and posterior (mean, 0.199 cm) branches matched the diameter of the thoracodorsal nerve (1-way analysis of variance, P = 0.557), confirming their ideal donor potential. Latissimus dorsi detrusor myoplasty using the posterior branch of the intrapelvic obturator nerve as the donor nerve was performed in 5 patients with neurogenic underactive bladder. Of 5 patients, 4 (80%) achieved restored voluntary voiding postoperatively, with postvoid residual volume decreasing significantly from 308.5 (187.5) to 62.0 (58.8) mL ( P = 0.042) and bladder contractility index improving significantly from 12.8 (5.7) to 151.9 (46.5) ( P = 0.007). These results demonstrate that latissimus dorsi detrusor myoplasty using the hemiobturator nerve is an effective surgical approach for functional detrusor reconstruction in patients with neurogenic underactive bladder.