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

Summary: This study presents a modified latissimus dorsi detrusor myoplasty (LDDM) technique using the hemi-obturator nerve for neurogenic underactive bladder (NUAB) reconstruction. Anatomical studies (n=22 hemipelves) revealed that the diameters of the anterior (mean: 0.209 cm) and posterior branches (mean: 0.199 cm) matched the thoracodorsal nerve’s diameter (one-way ANOVA, p = 0.557), confirming their ideal donor potential. LDDM by using posterior branch of intrapelvic obturator nerve as the donor nerve was performed in five patients with NUAB. 4/5 (80%) patients restored voluntary voiding postoperatively, with post-void residual volume (PVR) decreasing significantly from 308.5(187.5) mL to 62.0 (58.8) mL (P=0.042) and bladder contractility index (BCI) improving significantly from 12.8(5.7) to 151.9(46.5) (P=0.007). These results demonstrate that LDDM using the hemi-obturator nerve is an effective surgical approach for functional detrusor reconstruction in NUAB patients.