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
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.