Full-Thickness Hysterocystoplasty for Management of a Large Bladder Defect: Experimental Study in Goats

Abstract

ABSTRAcT. The uterine tissue of three healthy nonpregnant goats was evaluated experimentally as a graft for closure of a bladder defect. Goats were subjected to ovariectomy, and then one detubularized uterine horn was used as a graft to close a large defect in the ventral aspect of the bladder. Follow up included monthly radiographic and ultrasonographic examinations and evaluations of kidney function and electrolytes changes for six months. The goats were euthanized after six months, and both the bladder and the graft were examined macroscopically and histologically. The technique required less invasive procedures than those described with alternative techniques of cystoplasty, achieved a high survival rate without life-threatening complications post surgery, was associated with no significant changes in kidney function and electrolytes levels, showed proper healing of the transplanted graft by regeneration rather than repair without scaring or fibrosis and with complete covering of the graft by a healthy urothelium and was associated with no malignant transformation. Hysterocystoplasty is a noninvasive, non-life-threatening technique due to the close position of the bladder to the uterus, and proper healing of the graft reflects absence of pressure on its blood supply. It is an acceptable alternative technique for closure of a large bladder defect and avoids disadvantages of alternative techniques of cystoplasty. It might be accepted by owners of pets, and further studies in clinical cases of dogs are advised. Although cystoplasty is a historic topic that has been discussed well in scientific literature and argued at legendary proportion among urologists, the search for an ideal organ to replace a diseased bladder remains elusive for reconstructive urologists [32]. Many augmentation cystoplasty or neobladder techniques have been used routinely for treatment of reduced bladder compliance and capacity secondary to bladder infection and inflammation [27], neurogenic dysfunction or congenital bladder disorders [16], detrusor over activity [10], large bladder defects [8,9], bladder necrosis [30] and bladder tumors [7,12]. Although encouraging animal and human results have been reported with different techniques, each technique had its own limitations, complications and disadvantages [2,4,11,27].The ileum and colon have been used for decades for reconstruction of the bladder, in spite of the harmful contact of urine with the mucosa of the augmenting patch [23], which is predisposed to multiple short-and/or long-term complications like chronic bacteriuria or mucous secretion [1,23], stone formation [1,11,29], disturbance of calciumphosphate metabolism with potential bone growth retardation [24,28], altered hepatic and electrolyte metabolism [24], gastrointestinal motility disorders [23], augmenting patch perforation [1,6] and malignant transformation of the augmenting patch [1,14].Gastrocystoplasty has been described as an alternative technique; unfortunately, as the popularity of gastrocystoplasty increased, so did ...

Use of Fascia Lata Autograft for Augmentation of Bladder in Rabbits

“…Graft materials obtained from the gastrointestinal system are accepted as the gold standard today despite complications (3,16,17). It has been reported that grafts of intestinal segments have many complications such as chronic bacteriuria, stone formation, calcium-phosphate metabolism disturbance, growth retardation in bones, gastrointestinal motility disorders, mucus secretion, and fluid-electrolyte balance (1,8,16,17). In our study autogenous FL graft was used in augmentation of urinary bladder.…”

Cystometric analysis of the transplanted bladder

“…Diverse segments of the gastrointestinal tract, including gastric, small intestine and colon segments, have been employed for this aim ( 1 - 5 ). Alternative natural tissues taken from the uterus, peritoneum, lyophilized dura, pericardium and placenta have also been utilized for cystoplasty ( 6 - 12 ). Furthermore, synthetic materials such as Teflon, sylastic, polyvinyl sponges, poly-alpha amino or collagen/polyglactin membranes have also been tried ( 13 - 18 ).…”