An original technique for bladder autoaugmentation with protective abdominal rectus muscle flaps: An experimental study in rats

Citation
C. Manzoni et al., An original technique for bladder autoaugmentation with protective abdominal rectus muscle flaps: An experimental study in rats, J SURG RES, 99(2), 2001, pp. 169-174
Citations number
31
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
JOURNAL OF SURGICAL RESEARCH
ISSN journal
0022-4804 → ACNP
Volume
99
Issue
2
Year of publication
2001
Pages
169 - 174
Database
ISI
SICI code
0022-4804(200108)99:2<169:AOTFBA>2.0.ZU;2-0
Abstract
Background. Bladder autoaugmentation uses partial detrusorectomy to create a diverticular bulge in the bladder mucosa. This technique has eliminated c ertain serious complications of cystoplasty with gastrointestinal tissues ( e.g., fluid/electrolyte/acid-base imbalances, mucous hypersecretion), but t he exposed mucosa is subject to fibrosis and, sometimes, to perforation, wh ich can annul the benefits of surgery. Methods. We have developed an original technique based on traditional autoa ugmentation with protection of the herniated mucosa by split-thickness pedu nculated rectus abdominis muscle flaps that are sutured to the incised marg ins of the detrusor. Preliminary testing was done on 30 adult Wistar rats. A control group of 15 rats underwent laparotomy alone. Bladder capacity was measured via suprapubic cystography before and after (4 weeks, 8 weeks, I year) surgery, just before sacrifice. Sections of the reconstructed bladder were examined histologically. Results. Twenty-three bladder-augmented rats and 13 controls survived. In t he experimental group, bladder capacity increased by 38% (mean). None of th e rats experienced urinary retention, although one developed bladder stones . Histology revealed no pathologic changes (other than chronic inflammatory infiltrates at suture sites) in the mucosa, detrusor, or muscle flaps, whi ch were all viable and well integrated by the fourth postoperative week. Th ere were no signs of mucosal or muscle fibrosis. Conclusions. Preliminary results in a rat model suggest that this new techn ique can produce an enlarged bladder that is fully functional and less vuln erable to fibrotic retraction and rupture. Residual contractility in the mu scle flaps might theoretically be exploited to facilitate paraphysiologic m icturition. (C) 2001 Academic Press.