Chronic renal failure and bladder augmentation: stomach versus sigmoid colon in the canine model.

A canine model for chronic renal failure and bladder augmentation with a segment of stomach or sigmoid colon (or control) was developed to evaluate the possible benefit of net chloride ion excretion noted in an earlier canine model for gastrocystoplasty. Gastrocystoplasty animals behaved similar to control animals relative to the sigmoid cystoplasty animals, tolerated significantly greater acid loading, did not have hyperchloremia with acidosis and had less weight loss with acidosis. Gastrocystoplasty seems to be superior to sigmoid cystoplasty in the azotemic canine.

Gastrocystoplasty and colocystoplasty in canines: the metabolic consequences of acute saline and acid loading.

An experimental canine model was developed to quantitate the net transmural ion flux of colon and gastric segments used for augmentation cystoplasty. Gastrocystoplasty (4) or colocystoplasty (4) was constructed in 8 female mongrels. Acute intravenous saline and acid loading experiments were performed 2 to 4 weeks after cystoplasty. The mean solute excretion rates for sodium, chloride, phosphorus and ammonia exhibited opposite trends during acute saline and acid loading in this experimental model. The net flux of chloride, ammonia, phosphorus and sodium ions in the colocystoplasty animals was from the mucosa/urine surface to the serum (reabsorption). The opposite trend was true for the gastrocystoplasty. By not reabsorbing ammonium chloride, the gastrocystoplasty preserved an important renal mechanism for systemic acid elimination. This may help to prevent the hyperchloremic metabolic acidosis that can develop when urine comes in contact with small or large bowel segments.

Intestinocystoplasty and total bladder replacement in children and young adults: followup in 129 cases.

A review of 129 consecutive young patients (average age 13.4 years) who underwent intestinocystoplasty or total bladder replacement during a 6 1/2-year period at our institution is presented. The most common diagnosis was myelodysplasia and the average followup was 44 months. The clinical and urodynamic aspects of 4 types of intestinocystoplasty (ileocecal, tubular sigmoid, sigmoid patch and ileal patch) are presented. All 4 operations resulted in a significant increase in bladder volume, with a decrease in filling pressure and, thus, improved vesical compliance. In combination with clean intermittent catheterization renal function was maintained or improved in 91 per cent and urinary continence was achieved in 82 per cent of the patients. Hyperchloremic acidosis requiring therapy was noted only in patients with pre-existing renal insufficiency, although mild hyperchloremia after cystoplasty was seen with all 4 types of cystoplasty. There were no operative mortalities. Significant surgical complications occurred in 36 per cent of the patients, the most common of which was vesicoureteral reflux in the ileocecal cystoplasty. Mass unit peristaltic contractions occurred in 34 per cent of the tubular-shaped bowel segments compared to only 10 per cent of the patch segments. These peristaltic contractions contributed to the greater postoperative morbidity noted in the tubular large bowel cystoplasties. The over-all success rate for intestinocystoplasty in this series was 84 per cent. Intestinocystoplasty is an effective procedure when used to increase the compliance of the lower urinary tract. In combination with clean intermittent catheterization it can be applied successfully to patients with neurogenic bladder dysfunction. Large and small bowel seem to have similar clinical and urodynamic properties. The type of intestinal segment used for intestinocystoplasty seems to be of less importance than the size and configuration. Large bowel in its native tubular configuration should be avoided.

Spontaneous bladder rupture owing to atherosclerotic emboli: a case report.

We report a case of spontaneous intraperitoneal rupture of the bladder in an elderly man with severe atherosclerotic vascular disease who had widespread systemic evidence of an arterial embolic phenomenon after elective abdominal aortic aneurysm repair. Atherosclerotic plaques were identified in the vesical arteries and were believed to be the primary event responsible for spontaneous vesical perforation. The clinical presentation, diagnosis and principles of management of vesical rupture are discussed.