Aim 1: establish that functional electrical stimulation (FES) of specific anterior vesical branches of the pelvic nerve leading to the urinary bladder causes increased urinary bladder pressure in beating heart, brain dead human organ donors. Aim 2: develop a robotic-assisted laparoscopic approach for bladder reinnervation by nerve transfer of obturator nerve branches to anterior vesical branches of the pelvic nerve. This will form the foundation for a future clinical trial of nerve transfer surgery for restoration of bladder emptying function. Our ongoing preclinical canine studies over the past 18 years seek to develop surgical approaches to reinnervate the lower motor neuron-lesioned urinary bladder, urethra and anal sphincter. We had remarkable success and now plan to begin clinical translation. We clearly documented functional reinnervation of the bladder, assessed by induction of bladder contraction with electrical stimulation of transferred nerves when the reinnervation surgery is performed immediately after the decentralization,21 at one and three months20 and now at one year after decentralization.29 Because of this preclinical success, we propose clinical translation to human patients that have lost control of bladder emptying function. We have clearly demonstrated in cadavers that nerve transfer to the vesical branches of the pelvic nerve innervating to the urinary bladder is technically feasible using a variety of donor nerves.2,6,7 However, prior to drawing the conclusion that these methods will lead to functional detrusor reinnervation, we need to confirm that the anatomical configuration of these particular vesical branches of the pelvic nerve in humans is sufficiently similar to the animal model such that stimulation will result in effective detrusor contraction. This would provide the final evidence that the nerve transfer surgeries will be successful in human subjects. In contrast to the open laparoscopic approaches used in the animal model, establishing a robotic-assisted laparoscopic approach to obturator to pelvic nerve transfer for bladder reinnervation in non-embalmed cadavers will provide surgeons with expertise in the surgical procedures prior to a clinical trial and is expected, in comparison with the open procedure, to greatly reduce the recovery time and improve clinical outcomes. Long term impact: Successful confirmation in human cadavers and in beating heart organ donors will provide confidence that nerve transfer to these vesical branches of the pelvic nerve will reinnervate the detrusor and restore bladder emptying function to patients that have lost control of their bladder. There is no universally effective therapy for loss of detrusor activity, thus there is an urgent need to identify an effective treatment for this condition. The study described in this proposal will provide the final proof for the feasibility of reinnervation of the human urinary bladder for restoration of bladder emptying function and facilita...