Nonsecretory intestinocystoplasty: postoperative outcomes of 25 years

ABSTRACT Objective The objective of bladder augmentation (BA) is to create a low-pressure reservoir with adequate capacity. Despite its benefits, the use of intestinal patches in bladder enlargement provides a high risk of developing complications and BA with demucosalised bowel represents a potential alternative. Therefore, this study evaluated urological parameters and long-term clinical follow-up of patients submitted to non-secretory BA in a single center with 25 years of experience. Materials and Methods Patients treated with BA underwent urological evaluation, which included history, physical examination and urodynamic study. The main urodynamic parameters (bladder capacity and bladder compliance) were assessed in the pre and postoperative moments, and compared by the Wilcoxon Signed Rank test. The main long-term complications were described. Results 269 patients (mean age 14±13 years, 47% male) underwent BA with the use of demucolised intestinal segments. Among the patients in the sample, 187 (69.52%) had neurogenic bladder, 68 (25.28%) had bladder exstrophy, nine had tuberculosis (3.34%), four had a posterior urethral valve (1.49%) and one with hypospadia (0.37%). After the surgical procedure, a significant increment in both urodynamic parameters was found, with a 222% increase in bladder capacity and 604% in bladder compliance (p <0.001 in both analyzes). Mean follow-up time ranged from 2 to 358 months, with a median of 72 months (IQR 74-247). Among all patients, 5 presented spontaneous perforation. Conclusion The study showed statistically significant increase in both compliance and bladder capacity after non-secretory BA, with a low rate of severe complications.

Experimental use of a cellulosic biopolymer as a new material for suburethral sling in the treatment of stress urinary incontinence

Purpose: To analyze the interaction between the cellulose exopolysaccharide (CEC) and urethral tissue when used as a pubovaginal sling. Materials and Methods: Forty Wistar rats were divided into four groups. In groups A and B the cellulose exopolysaccharide (CEC) was implanted around the urethral tissue (bladder neck below the upper margin) and the rats were sacrificed at 30 and 90 days. Similar procedure was used in groups C and D using a polypropylene mesh. After sacrifice bladder and urethra were sent for histological analysis. The histological parameters (inflammatory reaction) by evaluated by quantitative analysis. For collagen deposition analysis it was used stereological method. Results: The cellulose exopolysaccharide (CEC) was inert and well preserved at the implanted region at the time of examination. Morphologic alterations were not found at the CEC implant but some reactions of foreign body type were observed at the adjacent structures. In some areas a process of neovascular formation was observed. Stereological analysis at the suburethral area showed a significant difference in collagen presence in favor of CEC. Conclusions: The CEC implant showed adequate results when used as a suburethral sling with good integration to the host tissue, preserving its architecture.

Use of the monti principle for constructing a continent gastrostomy

OBJECTIVE: To research technical alternatives for permanent gastrostomy that minimizes the drawbacks and complications reported by several authors. MATERIALS AND METHODS: An experimental model was developed where the material was divided into 2 groups: the study group (SG) composed of 12 half-breed dogs where the proposed technique was applied, and the control group (CG) composed of 10 animals where a gastrostomy as proposed by Webster in 1974 was applied. On the 90th postoperative day, both groups underwent tests for assessing competence concerning leakage. These were performed under general anesthesia and following sacrifice. RESULTS: In the SG, under anesthesia only one animal had leakage through the gastrostomy. Following sacrifice, leakage was observed in 2 animals. In the CG, under anesthesia, 2 animals had leakage and, following sacrifice, only 1 animal did not present leakage. On histopathological analysis of the SG, gastric mucosa was evidenced around the jejunal tubes, with normal features, moderate inflammatory mononuclear infiltrate in jejunal tubes and only slight infiltrate around the gastrostomy stoma. In the CG, ulceration was constant around the external stoma of the gastrostomy tubes. In the corium, the inflammatory infiltrate was less intense than in the SG. The SG proved to be more efficacious than the CG concerning leakage, and this efficacy is attributed to the submucous valvular system. CONCLUSION: The featured technique showed competence concerning leakage, allowing its clinical applicability as an alternative for permanent gastrostomy.

Total bladder replacement with de-epithelialized ileum: experimental study in dogs

OBJECTIVE: To assess the value of the silicone modeler in preventing graft retraction in dogs undergoing bladder replacement with de-epithelialized ileum. MATERIALS AND METHODS: Twelve female dogs underwent total cystectomy and bladder replacement by neobladder made of demucosalized ileal segment, comparing the group with modeler (group I) and the group without modeler (group II). Cystometry data, graft epithelization and radiological assessment (cystography and excretory urography) were analyzed. RESULTS: Neobladder capacity, at 2 months, ranged from 50 to 250 mL (mean 191 mL) and from 5 to 60 mL (mean 22 mL) and at 6 months, from 60 to 270 mL (mean 202.5 mL) and from 5 to 75 mL (mean- 30.5 mL), respectively in groups I and II, with a statistically significant difference between groups. After 30 days, postoperatively the presence of transitional epithelium was observed in all fragments obtained by biopsy. CONCLUSION: The use of the intravesical silicone modeler prevented the retraction of the neobladder of de-epithelialized ileum.