Living-related Partial Bladder Transplantation for Bladder Augmentation : An Experimental Study

点击翻译按钮获取中文摘要

Segments of gastrointestinal tract are commonly used for bladder augmentation (BA) to treat patients with neurogenic bladder or bladder exstrophy. However, when gastrointestinal tissue is in constant contact with urine, various significant post-BA complications, such as urolithiasis, metabolic acidosis, bladder perforation, increased mucous production, and tumor, can develop. In particular, any possible risk for malignancy in the intestinal segment used for BA is a matter of grave concern.To overcome post-BA complications associated with using enteric tissue, we developed a novel experimental technique for BA, which we tested in rats: living-related partial bladder transplantation (LPBTx). The short-term results were very encouraging and we planed the long-term results in a new series of Lewis rats, focusing on the risk for carcinogenesis in the neobladder.Long-term histopathologic changes after bladder augmentation (BA) in rats using living-related partial bladder transplantation (LPB … More Tx) or conventional ileocystoplasty (ICP) were compared. Rats that survived >10 mo after BA were killed after blood biochemistry and neobladder imaging. Harvested bladders were examined with hematoxylin and eosin and proliferating cell nuclear antigen (PCNA). When the rats were killed, ICP rats were significantly smaller than LPBTx rats. Mean serum pH in the LPBTx group was 7.41±0.78 and in the ICP group was 7.25±0.38. Mean base excess in the ICP group was significantly lower than in the LPBTx group. Incidence of bladder calculi in the LPBTx group (6.3%) was significantly lower than in the ICP group (33.3%). There was no dysplasia/malignancy/increase in PCNA in the LPBTx group. PCNA increased in the ICP group, compared with controls ; two (16.7%) of 12 of ICP rats had dysplasia with mitosis. Bladder capacity increased in LPBTx and ICP compared with controls. We hope to show that BA using LPBTx may result in a neobladder with fewer complications than BA using ICP ; LPBTx may also decrease the risk for malignancy. Less