Enterocystoplasty

Gough, D. C. S.; Guys, Jean Michel

doi:10.1007/3-540-30867-9_29

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…Treatment options (eg, enterocystoplasty, neurostimulation devices) have been somewhat beneficial, but the ultimate goal remains to prevent surgery by maintaining a larger-volume, compliant bladder 14–17…”

Section: Commentmentioning

confidence: 99%

The Effect of Epigenetic Therapy on Congenital Neurogenic Bladders—A Pilot Study

Hodges

Yoo

Mishra

et al. 2010

Urology

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OBJECTIVES-To demonstrate that human smooth muscle cells derived from neurogenic bladders produce more collagen in vitro than smooth muscle cells derived from normal bladders, and that epigenetic therapy may normalize this increased collagen production.METHODS-Human smooth muscle cells from normal (n = 3) and neurogenic bladders (n = 3) were cultured in normal culture media and at different concentrations of the histone deacetylase inhibitors trichostatin A, valproic acid, and the DNA methylation inhibitor 5-azacytidine (5-aza). Collagen type I and III gene expression was measured using real-time quantitative reverse transcription-polymerase chain reaction after varying doses of drug exposure. Cell viability was measured using trypan blue. RESULTS-The smooth muscle cells from neurogenic bladders released significantly more collagen than the normal bladder cells (mean 4.1 vs 1.8 μg/mL in control media) when grown in normal conditions. Treatment with trichostatin A at 50 ng/mL decreased the collagen level in cells from neurogenic bladders to almost normal levels (2.1 μg/mL). In addition, valproic acid treatment decreased collagen types I and III gene expression relative to controls, with maximal effect at 300 mg/mL. These treatments had little effect on cell viability. CONCLUSIONS-Histone deacetylase inhibitors decreased collagen production of smooth muscle cells from neurogenic bladders in vitro. These agents may be a means of effectively preventing bladder fibrosis in patients with this condition.In children with myelodysplasia, a primary concern is the maintenance of low bladder storage pressure. Elevated intravesical pressure caused by a poorly compliant bladder in patients with spinal dysraphism is associated with damage to the upper urinary tract, and if not appropriately treated, renal failure. 1 Many treatment modalities have been developed to prevent or treat this disease process. One example is the use of chronic oral antimuscarinic therapy from an early age, coupled with clean intermittent catheterization. 2 Intravesical instillation of oxybutynin and other agents also has been attempted. 3,4 However, these therapies vary in efficacy and are associated with a number of side effects. Thus, development of novel treatment options is desirable.Neuropathic bladders have an increased ratio of type-III to type-I collagen, with an absolute increase in the amount of type-III collagen. 5 This increased collagen content is at least in part produced by detrusor smooth muscle cells and is thought to be a major cause of

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Section: Commentmentioning

confidence: 99%

The Effect of Epigenetic Therapy on Congenital Neurogenic Bladders—A Pilot Study

Hodges

Yoo

Mishra

et al. 2010

Urology

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“…At the stage of bladder neck reconstruction the bladder capacity may be inadequate, and augmentation enterocystoplasty, with or without a Mitrofanoff stoma, is required. The complications of enterocystoplasty under these circumstances are well recognized [1,2] but here we describe a previously unreported occurrence of crippling perineal and/or penile pain, which was only alleviated by excision and replacement of the entire native bladder remnant.…”

Section: Introductionmentioning

confidence: 84%

Severe perineal pain after enterocystoplasty in bladder exstrophy

Phelps

Malone²

2004

BJU International

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OBJECTIVE To describe a previously unreported complication (severe perineal pain) after bladder reconstruction and enterocystoplasty in patients with bladder exstrophy. PATIENTS AND METHODS The notes were reviewed retrospectively for four patients (two boys and two girls) with classical bladder exstrophy who had severe penile or perineal pain after bladder reconstruction. They were all continent and using intermittent catheterization. A range of conservative management failed and all patients subsequently required excision of their native bladders between 1997 and 2000. RESULTS All four patients had perineal or penile pain which began 4 months to 8 years after bladder augmentation. Investigations included plain abdominal X‐ray, renal and bladder ultrasonography, computerized tomography of the pelvis, video‐urodynamics and cysto‐urethroscopy. When therapeutic interventions such as more frequent bladder washouts, analgesic and anticholinergic drugs, and cystolithotomy (two patients) were unsuccessful in alleviating the symptoms, all had their native bladder excised. Histological examination of the excised tissue showed neither normal urothelium nor enteric mucosa at the margins of the excision; two patients already had squamous metaplasia within what represented the bladder, and in the others squamous epithelium was present amongst the enteric mucosa. All four children were pain‐free with a follow‐up of 2–6 years. CONCLUSION All four patients developed severe referred bladder pain that was probably secondary to the abnormal retained bladder remnants. Cystectomy cured the pain and may also have removed a potential site of future malignant tumour.

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“…As an example, many of these patients have ventriculo‐peritoneal shunts with multiple interventions and revisions causing significant amount of adhesions and scarring. The rate of intestinal obstruction requiring surgery in general after augmentation cystoplasty is estimated at 1.7–10% depending on the series and duration of follow‐up .…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, we used a porcine model to compare standard open ileocystoplasty with robot‐assisted laparoscopic ileocystoplasty (RALI). We sought also to evaluate other potential benefits of RALI, especially in regard to the formation of intra‐abdominal adhesions, which play a role in development of intestinal obstruction, a relatively common complication in this patient population . The porcine model provides for this purpose the unique opportunity of performing necropsies and directly assessing the final surgical result.…”

Section: Introductionmentioning

confidence: 99%

Does robot‐assisted laparoscopic ileocystoplasty (RALI) reduce peritoneal adhesions compared with open surgery?

et al. 2013

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Objectives• To compare perioperative outcomes between open ileocystoplasty and robot-assisted laparoscopic ileocystoplasty (RALI) in a porcine model, as objective data comparing outcomes between these two approaches in children with neurogenic bladder are lacking.• We specifically examined differences in postoperative peritoneal adhesion formation between the groups. Materials and Methods• In all, 20 pigs were assigned to an open ileocystoplasty or RALI study arm. All the pigs underwent an initial urodynamic study (UDS). • In the RALI arm, reconstructive steps were performed intracorporeally using a standard da Vinci ® system. Postoperatively, variables including first stool, weight gain, and complications were recorded.• After 42 days, the pigs underwent a final UDS followed by adhesion assessment.• Intraperitoneal adhesions were quantified by a third-party 'blinded' surgeon according to previously described objective scoring systems. Results• Preoperative variables including UDS were similar in both groups.• Overall operating time was significantly shorter for open ileocystoplasty than for RALI (149 vs 287 min, P < 0.001, respectively). Postoperatively, all variables including time to first stool, weight gain, and urodynamic parameters were similar amongst the groups.• Pigs in the open arm developed significantly more adhesions (P = 0.02) and adhesions with a higher complexity (P = 0.04). Conclusions• In this porcine model, RALI achieved similar functional outcomes as the open approach, but required longer procedural times.• The number and complexity of surgical adhesions among the groups favoured the RALI cohort. This may be of clinical significance in the paediatric spina bifida population, who generally undergo multiple surgical procedures in their lifetime, with increased risk for development of adhesions and subsequent intestinal obstruction.

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Enterocystoplasty

Cited by 5 publications

References 29 publications

The Effect of Epigenetic Therapy on Congenital Neurogenic Bladders—A Pilot Study

The Effect of Epigenetic Therapy on Congenital Neurogenic Bladders—A Pilot Study

Severe perineal pain after enterocystoplasty in bladder exstrophy

Does robot‐assisted laparoscopic ileocystoplasty (RALI) reduce peritoneal adhesions compared with open surgery?

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