Fan Zhang1, Limin Liao2. 1. Department of Urology, China Rehabilitation Research Center, Rehabilitation College of Capital Medical University, Beijing, China. 2. Department of Urology, China Rehabilitation Research Center, Rehabilitation College of Capital Medical University, Beijing, China. Electronic address: lmliao@263.net.
Abstract
PURPOSE: Bladder augmentation with enterocystoplasty is the gold standard therapy for neurogenic bladder. The presence of gastrointestinal segments in the urinary tract has been associated with many complications. We investigated an alternative approach using small intestinal submucosa as scaffold for reconstruction. MATERIALS AND METHODS: We selected 8 candidates with poor bladder capacity and compliance for small intestinal submucosa cystoplasty. Candidate age ranged from 14 to 54 years, and included 6 patients with myelomeningoceles and 2 patients with spinal cord injuries. Serial urodynamics, cystograms, ultrasonography and serum analyses were used to assess the outcomes of surgery. RESULTS: Followup range was 11 to 36 months (mean 12). Compared to the preoperative findings there were significant increases in maximum bladder capacity (p<0.05) at the 3 and 12-month followup (170.1±75.7 ml preoperatively, 365.6±68.71 ml at 3 months and 385.5±52.8 ml at 12 months), an increase in bladder compliance (p<0.01) at the 12-month followup (5.9±4.0 ml/cm H2O preoperatively and 36.3±30.0 ml/cm H2O at 12 months) and a decrease in maximum detrusor pressure (p<0.05) at the 12-month followup (43.6±35.7 cm H2O preoperatively and 15.1±7.6 cm H2O at 12 months). Bowel function returned promptly after surgery. No metabolic consequences were noted and no urinary calculi were observed. Renal function was preserved. CONCLUSIONS: Small intestinal submucosa can be used as a scaffold for rebuilding a functional bladder. Tissue engineering technology provides a potentially viable option for genitourinary reconstruction in patients with neurogenic bladder.
PURPOSE: Bladder augmentation with enterocystoplasty is the gold standard therapy for neurogenic bladder. The presence of gastrointestinal segments in the urinary tract has been associated with many complications. We investigated an alternative approach using small intestinal submucosa as scaffold for reconstruction. MATERIALS AND METHODS: We selected 8 candidates with poor bladder capacity and compliance for small intestinal submucosa cystoplasty. Candidate age ranged from 14 to 54 years, and included 6 patients with myelomeningoceles and 2 patients with spinal cord injuries. Serial urodynamics, cystograms, ultrasonography and serum analyses were used to assess the outcomes of surgery. RESULTS: Followup range was 11 to 36 months (mean 12). Compared to the preoperative findings there were significant increases in maximum bladder capacity (p<0.05) at the 3 and 12-month followup (170.1±75.7 ml preoperatively, 365.6±68.71 ml at 3 months and 385.5±52.8 ml at 12 months), an increase in bladder compliance (p<0.01) at the 12-month followup (5.9±4.0 ml/cm H2O preoperatively and 36.3±30.0 ml/cm H2O at 12 months) and a decrease in maximum detrusor pressure (p<0.05) at the 12-month followup (43.6±35.7 cm H2O preoperatively and 15.1±7.6 cm H2O at 12 months). Bowel function returned promptly after surgery. No metabolic consequences were noted and no urinary calculi were observed. Renal function was preserved. CONCLUSIONS: Small intestinal submucosa can be used as a scaffold for rebuilding a functional bladder. Tissue engineering technology provides a potentially viable option for genitourinary reconstruction in patients with neurogenic bladder.