Transplantation/ImmunologyHisterocystoplasty: A Novel Surgical Procedure in the Rat
Introduction
Most surgical techniques for bladder augmentation partially substitute the bladder wall with gastrointestinal segments. However, enterocystoplasties are associated with complications 1, 2, 3, mostly due to the contact of the gastrointestinal tissue with urine, such as metabolic and electrolyte disturbances [4], urinary infections [5], urolithiasis [6], and neoplasia of the transplanted tissues [7].
The search for a suitable material to reconstruct the urinary tract has therefore been a challenging task. Different authors have tried to avoid the subsequent complications of using bowel for urinary tract reconstructions by employing different types of tissue templates to augment the bladder and induce native bladder regeneration [8], such as: allogenic bladder submucosa [9], chemically treated pericardium [10], placental membranes [10], and porcine small intestinal submucosa [11]. These patches have shown to epithelize with a neo-urothelium [10], though they still present complications like the retraction or shrinkage of the graft 12, 13.
Fraser et al. [14] described favorable and encouraging results with the use of a composite from de-epithelialized smooth muscle of uterine origin, seeded with cultured urothelium for bladder augmentation. Thus, in the present study, we describe and evaluate a new surgical technique for bladder augmentation using autologous uterine tissue in a rat model. We assess its feasibility and results by gross, histopathologic, and ecographic examination, and by analysis of systemic parameters in all the operated animals at predetermined time points postoperatively.
Section snippets
Material and Methods
This project was carried out in accordance with the European Communities Council Directive of 24 November 1986 (86/609/EEC) and with the Spanish policies regarding the care and use of animals for experimental procedures. All experimental protocols were reviewed and approved by the Animal Care and Use Committee of the University of Leon. A total of 42 female Wistar rats with ages ranging from 12 to 14 wk and mean weight of 252 g were evaluated. All the animals were in good health and kept in
Results
In all of the animals subjected to hysterocystoplasty, no intraoperative or postoperative complications were observed. All animals survived the surgical procedure and were able to void spontaneously, with normal frequency and pattern. The ultrasound examination of the abdomen showed no dehiscence of the surgical wound or leakage of urine into the abdomen. Neither was dilation of the bladder, upper urinary tract, or uterus observed. All the operated rats had constant weight increase from the
Discussion
In this study, a new experimental surgical technique has been designed for bladder augmentation using autologous uterine tissue. It was technically viable and easy to perform. The use of uterine segments has the added advantages of its close anatomic relationship with the bladder and that it is a readily available tissue. It has lower risk of bacterial infection than bowel as well as the avoidance of the potential risks associated with intestinal anastomosis [14].
All the rats recovered shortly
Conclusions
Hysterocystoplasty is a novel surgical technique for bladder augmentation in the rat using autologous uterine horn. This procedure presented no mortality and avoided some of the analytical alterations and surgical complications observed in other techniques of gastro- and enterocystoplasties. Hysterocystoplasty proved to be an easy and safe surgical procedure for bladder augmentation.
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Cited by (4)
Bladder autoaugmentation with protective autologous uterine flap. Experimental study in the rat
2013, International Journal of SurgeryCitation Excerpt :Contrarily, Fraser et al.18 describe inflammatory cells in every bladder augmented with uterine grafts, even in the segments further away from the reconstructed area. When performing hysterocystoplasty,19 fibrosis, urothelial papillomas, microcalcifications and granulomas were observed in the transition zone between the bladder and the uterine horn, in some of the operated animals; as well as inflammation of the lamina propria of the bladder and of the muscular layer of the uterine horn. All of these findings though, were not statistically significant.
Hysterocystoplasty: A new surgical technique for bladder reconstruction
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