The Xiao procedure treats neurogenic bladder caused by various reasons.

Post-Radical Surgery for Cervical, Rectal, and Sacrococcygeal Tumors, Patients May Experience Urinary and Fecal Incontinence.

Xiao procedure has effectively addressed these medical issues, with a success rate of over 90%. Patients can now urinate independently, without urinary tract infections, and with restored kidney function.

Every year, around the world, 600,000 people get uterine cancer and 1.8 million get colorectal cancer. Many of these people have radical surgeries to try to get rid of the cancer. But, during these radical surgeries, some patients end up with bladder damage. This leads to what’s called a neurogenic bladder. A conservative estimate suggests that there are about 10 million cases of neurogenic bladder caused by radical surgery for cervical cancer, rectal cancer, and sacrococcygeal tumor.

Xiao procedure has effectively addressed these medical issues, with a success rate of over 90%. Patients can now urinate independently, without urinary tract infections, and with restored kidney function.

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L5: The fifth lumbar vertebra in the spine, located in the lower back, supports the upper body and aids in movement.
S1: The first sacral vertebra, part of the sacrum, supports the lower back, hips, and legs, crucial for lower body stability and movement.

S3: The third sacral vertebra, part of the sacrum, connects the spine to the pelvis, assisting in supporting the upper body weight. S3 is primarily involved in controlling bladder and rectal functions.

Neurological Function

Making a vertical incision of 3-5cm to expose the left lumbosacral nerve root.
Using nerve electrophysiology to electrically stimulate each nerve root individually and observe the muscle electromyogram to identify the anterior root of the left L5 or S1.
Separating and cutting half or a quarter of the root at the intervertebral foramen.
Sequentially locating and cutting the anterior root of the left S3 at its origin from the spinal cord.
Performing microsurgical anastomosis of the distal end of the S3 root to the proximal end of the L5 root.

The Xiao Procedure Involves:

This procedure establishes the “skin-spinal cord central-bladder reflex arc,” which induces urination by stimulating the corresponding skin area of the lower limbs, thereby addressing urinary dysfunction.

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Xiao Procedure’s 90% Success Rate in Post-cancer Radical Surgery Urinary and Fecal Dysfunction

In recent years, Professor Xiao’s team has dedicated their efforts to new research opportunities arising from the relative decrease in hospital activities due to epidemic control measures. They have expanded the application of the Xiao procedure theory and surgery in obstetrics and gynecology, gastrointestinal surgery, and orthopedic oncology. This expansion has effectively addressed the global medical challenges of postoperative urinary and fecal dysfunction in cervical cancer, rectal cancer, and sacrococcygeal tumor radical surgeries.

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About Radical Surgery

Understanding Urinary Complications in Radical Surgeries

In women’s surgeries, urinary injuries are uncommon, occurring in 0.2% to 1% of cases. These can be immediate cuts or delayed leaks, often quickly fixed. However, in radical cancer surgeries, injury risks rise to 10%-30%. In less developed regions, complications like genital-urinary fistulas from untreated childbirth affect 90%. Bladder injuries are the most frequent, found in 54% of surgeries but typically repaired promptly[1].

We estimate that each year, about 300,000 uterus removal surgeries are done on women in the U.S. This number has changed over time. In 1998, about 543,812 women had this surgery. The number went up to 681,234 in 2002, but then it started to go down every year. By 2010, it dropped to 433,621 women. This means there were 36.4% fewer surgeries in 2010 than in 2002[2]. In total, over 2 million women in the U.S. have had their uterus removed. In China, with a population exceeding 1.4 billion, over 2.8 million patients undergo hysterectomy (uterus removal surgeries) procedures in hospitals of all levels annually. Around the world, the number is more than 10 million. Doctors believe that out of these, 6 million women may have trouble with their bladder because of nerve problems, known as neurogenic bladder.

Bladder injury during colorectal surgery is rare, happening in less than 1% of cases. Most information on bladder injuries is from gynecologic surgeries. However, the risk of bladder injury during colorectal surgery can go up due to inflammation or infection nearby, past pelvic surgery, cancer invasion, and previous radiation treatment. It’s estimated that over 2 million people globally have neurogenic bladder due to this surgery.

Identifying and Managing Bladder Injuries During Surgery

When doctors operate on the lower belly, they sometimes accidentally hurt the bladder. This is more common when removing the uterus. If they think the bladder or the tubes from the kidneys might be hurt, they check by using a special dye or looking directly. If there was previous radiation treatment, they take extra care to prevent more problems by using tissue from the belly. They use a tube, called a Foley catheter, to help the bladder heal for one to two weeks. If there’s a leak from the bladder, they might leave the catheter in longer.

For bladder injuries during uterus removal, whether through the belly or vagina, they often fix it with dissolvable stitches and use the catheter. They also fill the bladder with a blue solution to make sure it’s fixed. During camera surgery (laparoscopy), injuries can happen when inserting tools. To avoid this, they empty the bladder first and are very careful with tool placement.

If they suspect a bladder injury because of unusual signs like gas or blood in the urine bag, they test by filling the bladder with a blue solution. If there’s a leak, they know there’s an injury. They might also use an X-ray with dye to check further.

Small bladder injuries can heal with just the catheter, but bigger ones might need stitches and more time with the catheter. If an injury is found later, it might require surgery or just the catheter, depending on where it is. Sometimes, problems from injuries show up much later, especially after radiation.

For patients after radical surgery for cervical cancer, rectal cancer, and sacrococcygeal tumors, there may be urinary and fecal incontinence issues.

For patients after radical surgery for cervical cancer:

Globally, out of 7 million cases, 80% may experience urinary and fecal incontinence issues.

For patients after radical surgery for rectal cancer

Globally, out of 2 million cases, most may experience urinary and fecal incontinence issues.

Patients undergoing sacrococcygeal tumor radical surgery

Globally, around 1 million cases, 95% may experience urinary and fecal incontinence issues.