Laparoscopic mid sagittal hemicystectomy and bladder reconstruction with small intestinal submucosa and reimplantation of ureter into small intestinal submucosa

1-Year followup

Jaime Landman, Ephrem Olweny, Chandru Sundaram, Cassio Andreoni, William C. Collyer, Jamil Rehman, Travis Jerde, H. K. Lin, David I. Lee, Eva H. Nunlist, Peter A. Humphrey, Steven Y. Nakada, Ralph V. Clayman

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Purpose: We evaluated the long-term results of laparoscopic hemicystectomy and bladder replacement with small intestinal submucosa (SIS) with ureteral reimplantation into the SIS material. Materials and Methods: A total of 12 minipigs underwent laparoscopic hemicystectomy. Six pigs underwent bladder reconstruction with SIS and ipsilateral ureteral reimplantation. The remaining 6 control pigs underwent hemicystectomy and primary bladder closure with ipsilateral nephroureterectomy. Preoperative and followup evaluations included blood chemistry, radiography and urodynamic evaluations. The 6, 3, 6 and 9-week, and 12-month followup evaluations included biopsies. At 1 year the animals were sacrificed. Histopathological and contractility studies, and reverse transcriptase-polymerase chain reaction for growth factors and basement membrane components were performed. Results: Bladder capacity and bladder compliance were similar in the 2 groups at all time points. One pig per group died, that is a control at the 9-month evaluation due to an anesthetic complication and an SIS pig 7 months after bladder reconstruction due to spontaneous bladder rupture at the anastomotic site. In the SIS group 4 of 5 surviving pigs had unobstructed reimplanted ureters without evidence of hydroureteronephrosis, while 1 had high grade obstruction at the reimplantation site. Histopathology study after 1 year revealed muscle at the graft periphery and center but it consisted of small fused bundles with significant fibrosis. Nerves were present at the graft periphery and center but they were decreased in number. Conclusions: Laparoscopic SIS bladder reconstruction and ureteral reimplantation into the SIS after hemicystectomy are technically feasible. However, compared to primary bladder closure no advantage in bladder capacity or compliance was documented.

Original languageEnglish (US)
Pages (from-to)2450-2455
Number of pages6
JournalJournal of Urology
Volume171
Issue number6 I
DOIs
StatePublished - Jun 2004
Externally publishedYes

Fingerprint

Replantation
Ureter
Urinary Bladder
Swine
Compliance
Transplants
Miniature Swine
Spontaneous Rupture
Urodynamics
Reverse Transcriptase Polymerase Chain Reaction
Basement Membrane
Radiography
Anesthetics
Intercellular Signaling Peptides and Proteins
Fibrosis
Biopsy
Muscles

Keywords

  • Bladder
  • Intestine, small
  • Swine
  • Ureter
  • Urinary diversion

ASJC Scopus subject areas

  • Urology

Cite this

Laparoscopic mid sagittal hemicystectomy and bladder reconstruction with small intestinal submucosa and reimplantation of ureter into small intestinal submucosa : 1-Year followup. / Landman, Jaime; Olweny, Ephrem; Sundaram, Chandru; Andreoni, Cassio; Collyer, William C.; Rehman, Jamil; Jerde, Travis; Lin, H. K.; Lee, David I.; Nunlist, Eva H.; Humphrey, Peter A.; Nakada, Steven Y.; Clayman, Ralph V.

In: Journal of Urology, Vol. 171, No. 6 I, 06.2004, p. 2450-2455.

Research output: Contribution to journalArticle

Landman, Jaime ; Olweny, Ephrem ; Sundaram, Chandru ; Andreoni, Cassio ; Collyer, William C. ; Rehman, Jamil ; Jerde, Travis ; Lin, H. K. ; Lee, David I. ; Nunlist, Eva H. ; Humphrey, Peter A. ; Nakada, Steven Y. ; Clayman, Ralph V. / Laparoscopic mid sagittal hemicystectomy and bladder reconstruction with small intestinal submucosa and reimplantation of ureter into small intestinal submucosa : 1-Year followup. In: Journal of Urology. 2004 ; Vol. 171, No. 6 I. pp. 2450-2455.
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abstract = "Purpose: We evaluated the long-term results of laparoscopic hemicystectomy and bladder replacement with small intestinal submucosa (SIS) with ureteral reimplantation into the SIS material. Materials and Methods: A total of 12 minipigs underwent laparoscopic hemicystectomy. Six pigs underwent bladder reconstruction with SIS and ipsilateral ureteral reimplantation. The remaining 6 control pigs underwent hemicystectomy and primary bladder closure with ipsilateral nephroureterectomy. Preoperative and followup evaluations included blood chemistry, radiography and urodynamic evaluations. The 6, 3, 6 and 9-week, and 12-month followup evaluations included biopsies. At 1 year the animals were sacrificed. Histopathological and contractility studies, and reverse transcriptase-polymerase chain reaction for growth factors and basement membrane components were performed. Results: Bladder capacity and bladder compliance were similar in the 2 groups at all time points. One pig per group died, that is a control at the 9-month evaluation due to an anesthetic complication and an SIS pig 7 months after bladder reconstruction due to spontaneous bladder rupture at the anastomotic site. In the SIS group 4 of 5 surviving pigs had unobstructed reimplanted ureters without evidence of hydroureteronephrosis, while 1 had high grade obstruction at the reimplantation site. Histopathology study after 1 year revealed muscle at the graft periphery and center but it consisted of small fused bundles with significant fibrosis. Nerves were present at the graft periphery and center but they were decreased in number. Conclusions: Laparoscopic SIS bladder reconstruction and ureteral reimplantation into the SIS after hemicystectomy are technically feasible. However, compared to primary bladder closure no advantage in bladder capacity or compliance was documented.",
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T1 - Laparoscopic mid sagittal hemicystectomy and bladder reconstruction with small intestinal submucosa and reimplantation of ureter into small intestinal submucosa

T2 - 1-Year followup

AU - Landman, Jaime

AU - Olweny, Ephrem

AU - Sundaram, Chandru

AU - Andreoni, Cassio

AU - Collyer, William C.

AU - Rehman, Jamil

AU - Jerde, Travis

AU - Lin, H. K.

AU - Lee, David I.

AU - Nunlist, Eva H.

AU - Humphrey, Peter A.

AU - Nakada, Steven Y.

AU - Clayman, Ralph V.

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Y1 - 2004/6

N2 - Purpose: We evaluated the long-term results of laparoscopic hemicystectomy and bladder replacement with small intestinal submucosa (SIS) with ureteral reimplantation into the SIS material. Materials and Methods: A total of 12 minipigs underwent laparoscopic hemicystectomy. Six pigs underwent bladder reconstruction with SIS and ipsilateral ureteral reimplantation. The remaining 6 control pigs underwent hemicystectomy and primary bladder closure with ipsilateral nephroureterectomy. Preoperative and followup evaluations included blood chemistry, radiography and urodynamic evaluations. The 6, 3, 6 and 9-week, and 12-month followup evaluations included biopsies. At 1 year the animals were sacrificed. Histopathological and contractility studies, and reverse transcriptase-polymerase chain reaction for growth factors and basement membrane components were performed. Results: Bladder capacity and bladder compliance were similar in the 2 groups at all time points. One pig per group died, that is a control at the 9-month evaluation due to an anesthetic complication and an SIS pig 7 months after bladder reconstruction due to spontaneous bladder rupture at the anastomotic site. In the SIS group 4 of 5 surviving pigs had unobstructed reimplanted ureters without evidence of hydroureteronephrosis, while 1 had high grade obstruction at the reimplantation site. Histopathology study after 1 year revealed muscle at the graft periphery and center but it consisted of small fused bundles with significant fibrosis. Nerves were present at the graft periphery and center but they were decreased in number. Conclusions: Laparoscopic SIS bladder reconstruction and ureteral reimplantation into the SIS after hemicystectomy are technically feasible. However, compared to primary bladder closure no advantage in bladder capacity or compliance was documented.

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KW - Intestine, small

KW - Swine

KW - Ureter

KW - Urinary diversion

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