Ileocecal valve resistance augmentation using glutaraldehyde cross- linked collagen

A canine model for endoscopic salvage of the leaking Indiana reservoir

Joseph K. Izes, William Bihrle, Richard Bihrle

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: Periurethral injection of glutaraldehyde cross-linked collagen is a well-established modality for the treatment of patients with incontinence caused by structural defects at the bladder outlet. Little is known about the potential usefulness of this approach to the nonfunctioning continence mechanism of a leaking continent urinary reservoir. An animal model of an incontinent Indiana reservoir was created using the naturally incompetent canine ileocecal valve. The effectiveness and feasibility of endoscopic submucosal injection of glutaraldehyde cross-linked collagen into the ileocecal valve to increase resistance were examined. Materials and Methods: Seven beagle dogs underwent isolation of the ileocecal segment. The right colon and ileum were brought to the skin as 2 stomas. Baseline leak point pressures of the ileocecal valve were determined while infusing contrast material into the right colon. The leak point was observed fluoroscopically, and the pressure at which contrast material crossed the valve was measured. Glutaraldehyde cross-linked collagen, 4 to 10 ml., was injected endoscopically into the valve in a circumferential pattern. Leak point pressures were measured immediately, 1 month after injection and 3 months after injection. Results: An average of 7.1 gm. (range, 4.1 to 10.1 gm.) was required to create an endoscopically 'closed' ileocecal valve. Leak point pressure increased from a mean 3.8 mm. water (range, 2.5 to 6.0 mm. water) at baseline to mean 35.7 mm. water after injection (range, 22.0 to 57.0 mm. water). At 1 month, mean leak point pressure decreased slightly to 26.7 mm. water. This pressure stabilized at 3 months at 29.5 mm. water. Conclusions: Endoscopic delivery of glutaraldehyde cross-linked collagen into the ileocecal valve consistently enhanced resistance as measured by leak point pressure. This effect was durable over a 3-month period of observation. Admittedly, this period of observation is relatively short. Longer followup may have demonstrated significant diminution of collagen migration or resorption. However, this feasibility study demonstrates that collagen injections may provide a minimally invasive means of treating the incontinent continent urinary reservoir.

Original languageEnglish (US)
Pages (from-to)1369-1371
Number of pages3
JournalJournal of Urology
Volume158
Issue number4
DOIs
StatePublished - Oct 1997
Externally publishedYes

Fingerprint

Ileocecal Valve
Canidae
Pressure
Injections
Water
Continent Urinary Reservoirs
Contrast Media
Colon
Collagen
Observation
Feasibility Studies
glutaraldehyde-cross-linked collagen
Ileum
Urinary Bladder
Animal Models
Dogs
Skin

Keywords

  • Collagen
  • Ileocecal valve
  • Urinary diversion
  • Urinary incontinence

ASJC Scopus subject areas

  • Urology

Cite this

Ileocecal valve resistance augmentation using glutaraldehyde cross- linked collagen : A canine model for endoscopic salvage of the leaking Indiana reservoir. / Izes, Joseph K.; Bihrle, William; Bihrle, Richard.

In: Journal of Urology, Vol. 158, No. 4, 10.1997, p. 1369-1371.

Research output: Contribution to journalArticle

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abstract = "Purpose: Periurethral injection of glutaraldehyde cross-linked collagen is a well-established modality for the treatment of patients with incontinence caused by structural defects at the bladder outlet. Little is known about the potential usefulness of this approach to the nonfunctioning continence mechanism of a leaking continent urinary reservoir. An animal model of an incontinent Indiana reservoir was created using the naturally incompetent canine ileocecal valve. The effectiveness and feasibility of endoscopic submucosal injection of glutaraldehyde cross-linked collagen into the ileocecal valve to increase resistance were examined. Materials and Methods: Seven beagle dogs underwent isolation of the ileocecal segment. The right colon and ileum were brought to the skin as 2 stomas. Baseline leak point pressures of the ileocecal valve were determined while infusing contrast material into the right colon. The leak point was observed fluoroscopically, and the pressure at which contrast material crossed the valve was measured. Glutaraldehyde cross-linked collagen, 4 to 10 ml., was injected endoscopically into the valve in a circumferential pattern. Leak point pressures were measured immediately, 1 month after injection and 3 months after injection. Results: An average of 7.1 gm. (range, 4.1 to 10.1 gm.) was required to create an endoscopically 'closed' ileocecal valve. Leak point pressure increased from a mean 3.8 mm. water (range, 2.5 to 6.0 mm. water) at baseline to mean 35.7 mm. water after injection (range, 22.0 to 57.0 mm. water). At 1 month, mean leak point pressure decreased slightly to 26.7 mm. water. This pressure stabilized at 3 months at 29.5 mm. water. Conclusions: Endoscopic delivery of glutaraldehyde cross-linked collagen into the ileocecal valve consistently enhanced resistance as measured by leak point pressure. This effect was durable over a 3-month period of observation. Admittedly, this period of observation is relatively short. Longer followup may have demonstrated significant diminution of collagen migration or resorption. However, this feasibility study demonstrates that collagen injections may provide a minimally invasive means of treating the incontinent continent urinary reservoir.",
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