Evaluation of bladder function after gastrocystoplasty / 重庆医科大学学报

Objective:To evaluate the function of bladder after gastrocystoplasty.Methods:38 patients after gastrocystoplasty were analyzed by observing the micturition and examination of urodynamics and to investigate the function of bladder during the filling and the micturition.Results:In the 38 patients,voiding interval time was 3.2?1.7hours;unirary output was 320?110ml;maximual flow rate was 19?7.2 ml per second;intravcsical pressure during filling was 11.2?8.2 cmH 2O;maximual intravesical pressure during voiding was 58?21 cmH 2O;and maximual pressure of detrusor was 28?12 cmH 2O.In total 38 cases,residual urine was observed in 11 cases,and residual volume was 55?34ml.12 cases developed uracratia or enuresis.Conclusion:Filling function of bladder is satisfactory after gastrocystoplasty,the micturition is carried out mainly by the action of intra-abdominal pressure.The disturbance of function of the sensation of bladder and the urethral sphincter is possibly the common cause for uracratia or enuresis.

Clinical application and long-term follow-up of the substitution of a segmental sinus-body of stomach for urinary bladder / 中华泌尿外科杂志

Objective To evaluate the reconstruction of bladder using a segmental sinus-body of stomach on the basis of a clinical study.Methods We retrospectively reviewed the medical records,laboratory evaluations,imaging examinations,cystoscopy,urodynamic studies of 30 patients(17 men and 13 women;mean age,55 years;age range,21-69 years) who underwent the reconstruction of bladder using a segmental sinus-body of stomach.Of the 30 patients,24 had primary bladder cancer and 6 had tuberculous contracture of the bladder.Results After operation,the new gastric bladder worked well in keeping and emptying urine.All patients micturated through the urethra.The bladder capacity was 280-580 ml(mean,385 ml).The maximum urethral pressure was 20-60 cm H_2O(mean,49 cm H_2O).The filling bladder pressure was 5-15 cm H_2O(mean,12 cm H_2O).The maximum bladder pressure was 35-65 cm H_2O(mean,55 cm H_2O),and it was 28-60 cm H_2O(mean,46 cm H_2O) during urination.Qmax and post-void residual urine were 10-28 ml/s(mean,18 ml/s) and 5-85 ml(mean,20 ml),respectively.Follow-up ranged from 9 months to 24 years(mean,8.2 years).There were no disturbance of water and electrolyte metabolism,no vesicoureteral reflux,no uracratia,and no damage to renal function.Complications included perineal and vesical pain in 4 cases,enuresis in 5 cases,which gradually remitted 3-6 months after surgery,and bladder stone formation in 1 case,who underwent surgery again.At 3.5 years after surgery bladder tumor relapsed in 1 case,who then underwent transurethral resection of bladder tumor. Conclusions Our data show that the substitution of a segmental sinus-body of stomach for urinary bladder worth popularizing because of low complication rate and approximately normal urologic indexes.

A Study on the Gastrocystoplasty of the Rats / 대한비뇨기과학회지

PURPOSE: This study was to investigate how stomach flaps and graft adapt their normal function to the urinary milieu after gastrocystoplasty. Also, it was studied to find out whether the stomach graft can survive as a part of bladder and function effectively. MATERIALS AND METHODS: The rats were divided into 5 groups; 1) normal 2) partial cystectomy 3) gastrocystoplasty with left gastroepiploic artery 4) gastrocystoplasty with stomach graft 5) gastrocystoplasty with right gastroepiploic artery. Their bladder capacity, end-filling pressure, serum electrolytes, BUN/Cr and urinalysis were measured. And histological examinations were performed periodically on group 3 and 4. RESULTS: All rats of gastrocystoplasty with right gastroepiploic artery expired due to bleeding, vasovagal reflex and urine leakage. But most rats with left gastroepiploic artery and stomach graft survived. Their bladder capacity increased a little more than the partial cystectomy group. Their end-filling pressures were not significantly decreased compared with partial cystectomy group. Renal function and serum electrolytes remained normal throughout the study. Serum Na+ of gastrocystoplasty rats were significantly decreased compared with normal rats(p<0.05). Microscopic hematuria developed in 15% of gastrocystoplasty rats with left gastroepiploic artery. Histological examination showed the urothelialization from the site of anastomosis toward the central portion of the graft. There were hyperplastic and squamous metaplastic changes on the bladder mucosa adjacent to the transplanted gastric patch. Bladder ulceration was observed in the gastrocystoplasty group with left gastroepiploic artery, but not in the gastrocystoplasty group with stomach graft. The gastric glands were observed and alive throughout the study in the gastrocystoplasty group with left gastroepiploic artery, but were not seen at postoperative 4 weeks in the gastrocystoplasty group with stomach graft. CONCLUSIONS: Based on the experimental data, it is suggested that augmentation gastrocystoplasty with left gastroepiploic artery pedicle is preferable to right gastroepiploic artery pedicle. It was concluded that the gastrocystoplasty using stomach graft and flap in rats could adapt to the bladder urodynamically, histologically and biochemically, and that the stomach graft could be used as one method of complete tissue graft.

An Experience of Augmentation Gastrocystoplasty in the Treatment of a Child with Spastic Neurogenic Bladder / 대한비뇨기과학회지

A small capacity, poor compliant neurogenic bladder is a difficult problem in children. Bladder augmentation with intermittent catheterization offers an alternative to indwelling catheterization. Ileum, cecum, and sigmoid colon have been most commonly used for enterocystoplasty but may, however, cause hyperchloremic metabolic acidosis. The use of the stomach to create urinary reservoir has several theoretical and real advantages. Electrolyte reabsorption is diminished which makes the stomach the selected reservoir. Hyperchloremic metabolic acidosis would not be a problem. In fact, in addition to presenting a barrier against the absorption of chloride and ammonium, the gastric mucosa secretes chloride ions. Gastric segment was isolated with right gastroepiploic artery as a pedicle. Bladder was opened vertically and augmented with gastric segment. This case had increased bladder volume and the dilatation of upper urinary tract decreased in size, including loss of VUR. Laboratory examination showed no metabolic derangement in blood gas analysis and electrolytes. We did not encounter any troubles in CIC such as the obstruction caused by mucus produced by gastric segment. Also, in patients in whom shortening of the bowel may be expected to lead to variable degrees of malabsorption, stomach is an attractive alternative. So, gastrocystoplasty is a reliable method of a creating a large and compliant urinary reservoir. We report a case of augmentation gastrocystoplasty in the treatment of spastic neurogenic bladder in a 6-year-old female.

Early experience of gastrocystoplasty for tuberculous contracted bladder / 대한비뇨기과학회지

Recently the stomach has been used with increasing frequency as an alternative to other bowel segments for auementing the bladder. The proposed advantages include decreased mucus production, reduced urinary infection due to an acid milieu, decreased metabolic abnormalities secondary to chloride excretion, and potential availability in patients with limited bowel length. The wedge gastrocystoplasty was performed in three patients of tuberculous contracted bladder, 2 females and 1 male, aged 22,51 and 57 years. On the excretory urogram, postoperative hydronephrosis was slightly improved as compared with preoperative one. Voiding cystogram showed no vesicoureteral reflux with reasonable capacity in all patients. Urgency, frequency, incontinence and voiding difficulty disappeared within 1 month postoperatively. When postoperative urodynamic studies were compared with the preoperative evaluation, it was noted that overall capacity was increased to an average of 235% (range 91 to 460%) at 2 months after surgery. Compliance has also improved dramatically after surgery. Three patients have been followed for at least 5 months, with the longest followup being 9 months. All patients reveal normal voiding patterns without gastric or urinary complications. We believe that a gastric segment is a suitable alternative to an intestinal segment especially in azotemic patient for reconstructine the urinary bladder. But the longterm effects of gastric augmentation remains to be determined.