Fan Zhang1,2, Limin Liao3,4. 1. Department of Urology, Fengtai District, China Rehabilitation Research Center, 10 JiaomenBeilu, Beijing, 100068, China. 2. Department of Urology of Capital Medical University, Beijing, China. 3. Department of Urology, Fengtai District, China Rehabilitation Research Center, 10 JiaomenBeilu, Beijing, 100068, China. lmliao@263.net. 4. Department of Urology of Capital Medical University, Beijing, China. lmliao@263.net.
Abstract
PURPOSE: To evaluate the long-term effect of using small intestinal submucosa (SIS) for bladder augmentation in patients with neurogenic bladder. MATERIALS AND METHODS: A total of 15 patients (age range 14-65 years; mean age 29.6 years) were enrolled in our study. The patients had poor bladder capacity and compliance caused by a neurogenic disorder requiring bladder augmentation. A small intestinal submucosa (SIS) cystoplasty was performed alone or in combination with ureter reimplantation. We prospectively followed the cohort to assess the urodynamics parameters, morphologic changes and patient satisfaction and evaluate the clinical benefit of the SIS procedure in long term. The surgical indications and complications were analyzed. RESULTS: The duration of follow-up ranged from 4.5 to 8.3 years (mean 6.3 years). Nine patients had expected long-term benefit, leading to an overall success rate of 60%. Two patients experienced immediate failure, and four patients slowed decrease in bladder capacity over time. Compared with the baseline data, there were significant increases in bladder capacity (163.5 ± 80.90-275.6 ± 159.5 ml, p < 0.05) and a significant decrease in maximum detrusor pressure (45.07 ± 29.03-17.60 ± 10.34 cmH2O, p < 0.05). Histologic examinations showed a complete conversion of SIS, leaving the urothelial lining and bladder wall containing muscular, vascular, and relatively thick connective tissue. Major complications included vesicoureteral reflux in five patients, bladder stone formation in one patient, and bladder perforation in one patient. CONCLUSION: Bladder augmentation with an SIS graft offers a partial long-term success rate in neurogenic bladder patients. This procedure cannot be recommended as a substitute for enterocystoplasty, especially in patients with severe upper urinary tract deterioration and/or bladder fibrosis.
PURPOSE: To evaluate the long-term effect of using small intestinal submucosa (SIS) for bladder augmentation in patients with neurogenic bladder. MATERIALS AND METHODS: A total of 15 patients (age range 14-65 years; mean age 29.6 years) were enrolled in our study. The patients had poor bladder capacity and compliance caused by a neurogenic disorder requiring bladder augmentation. A small intestinal submucosa (SIS) cystoplasty was performed alone or in combination with ureter reimplantation. We prospectively followed the cohort to assess the urodynamics parameters, morphologic changes and patient satisfaction and evaluate the clinical benefit of the SIS procedure in long term. The surgical indications and complications were analyzed. RESULTS: The duration of follow-up ranged from 4.5 to 8.3 years (mean 6.3 years). Nine patients had expected long-term benefit, leading to an overall success rate of 60%. Two patients experienced immediate failure, and four patients slowed decrease in bladder capacity over time. Compared with the baseline data, there were significant increases in bladder capacity (163.5 ± 80.90-275.6 ± 159.5 ml, p < 0.05) and a significant decrease in maximum detrusor pressure (45.07 ± 29.03-17.60 ± 10.34 cmH2O, p < 0.05). Histologic examinations showed a complete conversion of SIS, leaving the urothelial lining and bladder wall containing muscular, vascular, and relatively thick connective tissue. Major complications included vesicoureteral reflux in five patients, bladder stone formation in one patient, and bladder perforation in one patient. CONCLUSION:Bladder augmentation with an SIS graft offers a partial long-term success rate in neurogenic bladderpatients. This procedure cannot be recommended as a substitute for enterocystoplasty, especially in patients with severe upper urinary tract deterioration and/or bladder fibrosis.
Authors: Giorgio Bozzini; Lorenzo Berti; Matteo Maltagliati; Umberto Besana; Alberto Calori; Alexander Müller; Maria Chiara Sighinolfi; Salvatore Micali; Antonio Luigi Pastore; Rodrigo Ledezma; Paolo Broggini; Bernardo Rocco; Carlo Buizza Journal: World J Urol Date: 2020-09-14 Impact factor: 4.226
Authors: Massimo Garriboli; Koichi Deguchi; Giorgia Totonelli; Fanourios Georgiades; Luca Urbani; Marco Ghionzoli; Alan J Burns; Neil J Sebire; Mark Turmaine; Simon Eaton; Paolo De Coppi Journal: Pediatr Surg Int Date: 2022-03-22 Impact factor: 1.827