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Bladder Augmentation (bladder + augmentation)
Selected AbstractsUSE OF PORCINE SMALL INTESTINAL SUBMUCOSA IN BLADDER AUGMENTATION IN RABBIT: LONG-TERM HISTOLOGICAL OUTCOMEANZ JOURNAL OF SURGERY, Issue 1-2 2008Ali Ayyildiz Aim: To investigate long-term histological features of bladder augmentation using porcine small intestine submucosa (SIS) in a rabbit model. Materials and method: Sixteen New Zealand rabbits were used. Porcine SIS was provided by a manufactured formation derived from the pig. After partial cystectomy was carried out on the bladder, a single layer of SIS (Cook® -SIS Technology, Cook Biotech Incorporated, West Lafayette, IN, USA) (2 × 5 cm) was sewn to bladder with continuous 5/0 vicryl suture material in a watertight manner. Urinary diversion was not used. The rabbits were killed 12 months later and perivesical fat was removed together with bladder. The 5-,m preparations taken from the samples were stained with haematoxylin,eosin and Mason's trichrome dye. S-100 and F8 stains were also used for immunohistochemical investigations. Results: The macroscopic view of bladder was normal. SIS was indistinguishable from normal bladder wall, but the region of the graft had a slight white coloration. Microscopic observations showed the continuity of transitional epithelium of host bladder tissue on SIS material. Detrusor and serosal layers were formed and these layers were indistinguishable from host bladder. Fibroblasts were scattered among the collagen fibrils. New vessel formations were present without lymphatic proliferation. Nerve regeneration was excellent. No inflammation was observed in normal and regenerated bladder wall. Conclusion: At the end of 12 months, the long-term histological features of bladder augmentation with porcine SIS in a rabbit model, such as presence of new vessel formations, nerve regeneration, collagen and smooth muscle regenerations, which were indistinguishable from original bladder, and the absence of inflammation, showed that SIS seems to be a viable alternative to the use of intestine in bladder augmentation. [source] Global analysis of gene expression profiles in ileum in a rat bladder augmentation model using cDNA microarraysINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2004HIDEAKI MIYAKE Abstract Background: The objective of the present study was to globally characterize the changes in the gene expression profile in the ileum after long-term urine exposure in a rat ileal augmented bladder model using cDNA microarrays. Methods: Bladder augmentation using the ileum was performed in female 8-week-old rats. The ileal epithelia used for bladder augmentation were harvested 1 and 3 months postoperatively and changes in the gene expression in these tissues were compared with that of intact ileal epithelia from sham-operated rats using cDNA microarrays consisting of 1176 rat genes. Results: Marked changes in gene expression in the ileum used for bladder augmentation were observed for 30 genes (16 up-regulated and 14 down-regulated genes). The differentially expressed genes include those associated with signal transduction, cell adhesion and stress response. Subsequent evaluation of changes in two randomly selected genes from the 30 differentially expressed genes by semiquantitative reverse transcription-polymerase chain reaction demonstrated the reliability of the present cDNA microarray analyses. Conclusion: The present experiments identified an extensive list of genes differentially expressed in the ileum after bladder augmentation, providing valuable information for the pathophysiological assessment of patients who undergo urinary reconstruction and representing a source of novel targets for treating complications after urinary diversion. [source] USE OF PORCINE SMALL INTESTINAL SUBMUCOSA IN BLADDER AUGMENTATION IN RABBIT: LONG-TERM HISTOLOGICAL OUTCOMEANZ JOURNAL OF SURGERY, Issue 1-2 2008Ali Ayyildiz Aim: To investigate long-term histological features of bladder augmentation using porcine small intestine submucosa (SIS) in a rabbit model. Materials and method: Sixteen New Zealand rabbits were used. Porcine SIS was provided by a manufactured formation derived from the pig. After partial cystectomy was carried out on the bladder, a single layer of SIS (Cook® -SIS Technology, Cook Biotech Incorporated, West Lafayette, IN, USA) (2 × 5 cm) was sewn to bladder with continuous 5/0 vicryl suture material in a watertight manner. Urinary diversion was not used. The rabbits were killed 12 months later and perivesical fat was removed together with bladder. The 5-,m preparations taken from the samples were stained with haematoxylin,eosin and Mason's trichrome dye. S-100 and F8 stains were also used for immunohistochemical investigations. Results: The macroscopic view of bladder was normal. SIS was indistinguishable from normal bladder wall, but the region of the graft had a slight white coloration. Microscopic observations showed the continuity of transitional epithelium of host bladder tissue on SIS material. Detrusor and serosal layers were formed and these layers were indistinguishable from host bladder. Fibroblasts were scattered among the collagen fibrils. New vessel formations were present without lymphatic proliferation. Nerve regeneration was excellent. No inflammation was observed in normal and regenerated bladder wall. Conclusion: At the end of 12 months, the long-term histological features of bladder augmentation with porcine SIS in a rabbit model, such as presence of new vessel formations, nerve regeneration, collagen and smooth muscle regenerations, which were indistinguishable from original bladder, and the absence of inflammation, showed that SIS seems to be a viable alternative to the use of intestine in bladder augmentation. [source] Total phalloplasty using a musculocutaneous latissimus dorsi flapBJU INTERNATIONAL, Issue 4 2007Sava V. Perovic Authors from Serbia describe their experience of total phalloplasty in children and adults using a musculocutaneous latissimus dorsi free flap, finding that this method successfully allowed the creation of a neophallus, facilitating subsequent urethroplasty and the safe insertion of a penile prosthesis. In the second article in this section, authors from Finland present the findings in 54 patients relating to skeletal health after intestinal bladder augmentation. OBJECTIVE To present total phalloplasty in children and adults using a musculocutaneous latissimus dorsi (MLD) free flap to create a large neophallus, that allows easy urethroplasty and implantation of a prosthesis. PATIENTS AND METHODS From April 1999 to January 2006, 16 patients (mean age 24 years, range 10,34) had a total phalloplasty; the indications were congenital anomalies of the penis in 12, iatrogenic in two and accidental penile trauma in two. The MLD flap is mobilized on a subscapular artery and vein, and a thoracodorsal nerve. The neophallus is created on-site and after dividing the neurovascular pedicle, transferred to the pubic region, where it is anastomosed with the femoral artery, saphenous vein and ilio-inguinal nerve. The donor site was closed directly in 15 patients while in one a split-thickness skin graft was used to cover the defect. In the following stages, two- or three-stage buccal mucosa urethroplasty was used in 11 patients; a penile prosthesis was implanted in seven. RESULTS The mean (range) follow-up was 31 (12,74) months; the penis was 14,18 cm long and 11,15 cm in circumference. There was no partial or total flap necrosis; the donor site healed satisfactorily in 13 patients while in the remaining three there was moderate scarring. The patency of the urethra was good in all patients. Two urethrocutaneous fistulae developed; one closed spontaneously and the other was successfully treated with minor surgery. The function of the implanted penile prostheses was satisfactory in all patients. CONCLUSIONS The MLD flap allows the creation of a neophallus of good size and with a good aesthetic appearance; it allows urethroplasty and safe implantation of a penile prosthesis, and it can also be used in children. [source] Colpo-wrap: a new continence procedureBJU INTERNATIONAL, Issue 7 2005Thomas M. Boemers OBJECTIVE To present a new surgical method to increase bladder outlet resistance for the treatment of urinary incontinence in girls and women. PATIENTS AND METHODS Six patients (mean age 9.6 years), with urinary incontinence were operated using the new technique within the last 3 years. The principle of the procedure is tightening of the bladder neck by mobilizing the anterior vaginal wall and wrapping it around the bladder neck and proximal urethra, in the sense of a vaginoplication (colpoplication). The underlying conditions and causes for urinary incontinence was neurogenic bladder-sphincter dysfunction caused by myelodysplasia in three girls and anorectal malformation combined with a tethered spinal cord in one. In one case incontinence was caused by a cloacal anomaly and one girl had intrinsic sphincter insufficiency after repetitive Otis urethrotomies. The colpo- wrap was combined with a bladder augmentation and Mitrofanoff in three patients, the three other girls undergoing isolated procedures. RESULTS The result of the method is a constant increase in outlet resistance and coaptation of the urethra, comparable with the effect of a vaginal sling procedure. Five patients are completely dry after surgery, one girl with cloaca needed an additional bladder neck injection with hyaluranon/dextranomer copolymer. Transurethral catheterization was possible after surgery with no problems in all patients who required intermittent catheterization. CONCLUSION Considering the feasibility of this technique the colpo-wrap is a reasonable alternative for treating urinary incontinence in females. [source] Severe perineal pain after enterocystoplasty in bladder exstrophyBJU INTERNATIONAL, Issue 6 2004S.R. Phelps 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. [source] Expanded PTFE bladder neck slings for incontinence in children: the long-term outcomeBJU INTERNATIONAL, Issue 1 2004P. Godbole OBJECTIVE To assess the long-term outcome of circumferential expanded PTFE (Gore-texTM, WL Gore Associates, Scotland) bladder neck slings for achieving urethral continence in children with a neuropathic bladder. PATIENTS AND METHODS The records were reviewed of 19 children undergoing bladder reconstruction (most with a neuropathic bladder) who had a Gore-tex sling placed circumferentially at the bladder neck, over a 5-year period. Of these, seven had spina bifida; two each spinal dysraphism, surgery for anorectal anomalies and an idiopathic neuropathic bladder; five who developed a neuropathic bladder from other causes, and one born with bladder exstrophy. All children had an uncompliant bladder with a low urethral leak-point pressure on preoperative urodynamics. In all children conventional clean intermittent catheterization and pharmacotherapy had failed. Four had had previous augmentation surgery while 15 had concomitant bladder augmentation and formation of a Mitrofanoff stoma. The main outcome measure was achieving dryness. The original intention of the procedure was also to maintain urethral catheterization. RESULTS Full details of the follow-up were available in 17 patients. Despite initial good short-term results, at a median follow up of 7 years, in 14 patients the sling had to be removed because of erosion, often with transient urethral leakage before the bladder neck subsequently closed. A bladder calculus was associated with each case of erosion except one. CONCLUSION Although in the short term this technique had favourable results, it was not a useful technique in the long term. [source] | ||||||||||