In situ Reversed Ileocystoplasty for Less Invasive Augmentation Cystoplasty: An Experimental Study

Abstract

Purpose: To evaluate the application of a reversed intact ileal patch for augmentation cystoplasty in terms of improvements in bladder urodynamics and to eliminate the need for bowel anastomosis in an experimental model. Methods: 12 cross-bred adult dogs were used for reversed seromuscular ileocystoplasty with intact bowel segment. The procedure was comprised of selecting a 7- to 10-cm ileal loop from about 20 cm proximal to the ileocecal valve. The seromuscular layer of the ileal loop from its antimesenteric aspect was sutured to the bladder mucosa of the previously bivalved bladder with running stitches. Results: 10 animals survived and completed their 4-week follow-up period. Postoperative urodynamic study revealed a 26% increase of mean maximal cystometric capacity [from 226 to 285 ml (p = 0.002)] and a significant increase in mean bladder compliance [from 11.8 to 17.8 ml/cm H₂O (p = 0.002)]. Mean maximal detrusor filling pressure decreased significantly from 20 to 16.1 cm H₂O (p = 0.011). Histopathologic examination of the augmented bladder showed complete epithelialization of the serosal surface of ileum with layers of transitional urothelium. Conclusions: The early results of this less invasive technique were promising in terms of improvements in bladder urodynamic variables and growth of transitional urothelium. Longer follow-up is necessary to show the durability of these effects.

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

“…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 awareness of its potential complications, like hematuria, stricture, rupture of the gastric segment, adenocarcinoma formation and hypochloremic alkalosis, which is much more difficult to treat than chronic metabolic acidosis. Accordingly, gastrocystoplasty is no longer a safe method for bladder augmentation [4,11,26].…”

“…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].…”