Multilayered small intestinal submucosa is inferior to autologous bowel for laparoscopic bladder augmentation

Ryan F. Paterson, David A. Lifshitz, Stephen D W Beck, TIBÉRIO M. Siqueira, Liang Cheng, James E. Lingeman, Arieh L. Shalhav

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Purpose: Bladder augmentation is most commonly performed with ileum. However, porcine small intestinal submucosa has been reported as a substitute for bowel for incorporation into the urinary tract. We assessed the feasibility and long-term 12-month results of laparoscopic bladder augmentation with ileum or multilayered small intestinal submucosa (Cook Biotech, Spencer, Indiana) in a porcine model. Materials and Methods: We performed laparoscopically assisted hemicystectomy and bladder augmentation in 24 female Yucatan mini-pigs using an ileal segment (12) or multilayered small intestinal submucosa (12). The followup protocol included anesthetic bladder capacity, renal ultrasonography and serum chemistry. At 3, 6 and 12 months, respectively, 4 animals per group were scheduled for sacrifice and pathological analysis. Results: Despite longer anastomotic time in the multilayered small intestinal submucosa group (120 versus 91 minutes, p = 0.026) total operative time was similar in the 2 groups. In each group bladder capacity increased with time but by 12 months bladder capacity was significantly better in the bowel than in the small intestinal submucosa group (825 versus 431 cc, p = 0.016). At 3 months pathological evaluation revealed that the multilayered regenerated bladder patch had shrunken and by 6 months it was replaced by dense calcified scar tissue. Long-term 6 and 12-month bladder capacity in the small intestinal submucosa group was the result of the regeneration of native bladder with exclusion of the whole multilayered patch in the majority of cases. Conclusions: Laparoscopic bladder augmentation using multilayered small intestinal submucosa produced functional and pathological results inferior to those of bowel at 12-month followup in a porcine model.

Original languageEnglish
Pages (from-to)2253-2257
Number of pages5
JournalJournal of Urology
Volume168
Issue number5
StatePublished - Nov 1 2002

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Urinary Bladder
Swine
Ileum
Operative Time
Urinary Tract
Cicatrix
Anesthetics
Regeneration
Ultrasonography
Kidney
Serum

Keywords

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

ASJC Scopus subject areas

  • Urology

Cite this

Paterson, R. F., Lifshitz, D. A., Beck, S. D. W., Siqueira, TIBÉRIO. M., Cheng, L., Lingeman, J. E., & Shalhav, A. L. (2002). Multilayered small intestinal submucosa is inferior to autologous bowel for laparoscopic bladder augmentation. Journal of Urology, 168(5), 2253-2257.

Multilayered small intestinal submucosa is inferior to autologous bowel for laparoscopic bladder augmentation. / Paterson, Ryan F.; Lifshitz, David A.; Beck, Stephen D W; Siqueira, TIBÉRIO M.; Cheng, Liang; Lingeman, James E.; Shalhav, Arieh L.

In: Journal of Urology, Vol. 168, No. 5, 01.11.2002, p. 2253-2257.

Research output: Contribution to journalArticle

Paterson, RF, Lifshitz, DA, Beck, SDW, Siqueira, TIBÉRIOM, Cheng, L, Lingeman, JE & Shalhav, AL 2002, 'Multilayered small intestinal submucosa is inferior to autologous bowel for laparoscopic bladder augmentation', Journal of Urology, vol. 168, no. 5, pp. 2253-2257.
Paterson RF, Lifshitz DA, Beck SDW, Siqueira TIBÉRIOM, Cheng L, Lingeman JE et al. Multilayered small intestinal submucosa is inferior to autologous bowel for laparoscopic bladder augmentation. Journal of Urology. 2002 Nov 1;168(5):2253-2257.
Paterson, Ryan F. ; Lifshitz, David A. ; Beck, Stephen D W ; Siqueira, TIBÉRIO M. ; Cheng, Liang ; Lingeman, James E. ; Shalhav, Arieh L. / Multilayered small intestinal submucosa is inferior to autologous bowel for laparoscopic bladder augmentation. In: Journal of Urology. 2002 ; Vol. 168, No. 5. pp. 2253-2257.
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AU - Lifshitz, David A.

AU - Beck, Stephen D W

AU - Siqueira, TIBÉRIO M.

AU - Cheng, Liang

AU - Lingeman, James E.

AU - Shalhav, Arieh L.

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N2 - Purpose: Bladder augmentation is most commonly performed with ileum. However, porcine small intestinal submucosa has been reported as a substitute for bowel for incorporation into the urinary tract. We assessed the feasibility and long-term 12-month results of laparoscopic bladder augmentation with ileum or multilayered small intestinal submucosa (Cook Biotech, Spencer, Indiana) in a porcine model. Materials and Methods: We performed laparoscopically assisted hemicystectomy and bladder augmentation in 24 female Yucatan mini-pigs using an ileal segment (12) or multilayered small intestinal submucosa (12). The followup protocol included anesthetic bladder capacity, renal ultrasonography and serum chemistry. At 3, 6 and 12 months, respectively, 4 animals per group were scheduled for sacrifice and pathological analysis. Results: Despite longer anastomotic time in the multilayered small intestinal submucosa group (120 versus 91 minutes, p = 0.026) total operative time was similar in the 2 groups. In each group bladder capacity increased with time but by 12 months bladder capacity was significantly better in the bowel than in the small intestinal submucosa group (825 versus 431 cc, p = 0.016). At 3 months pathological evaluation revealed that the multilayered regenerated bladder patch had shrunken and by 6 months it was replaced by dense calcified scar tissue. Long-term 6 and 12-month bladder capacity in the small intestinal submucosa group was the result of the regeneration of native bladder with exclusion of the whole multilayered patch in the majority of cases. Conclusions: Laparoscopic bladder augmentation using multilayered small intestinal submucosa produced functional and pathological results inferior to those of bowel at 12-month followup in a porcine model.

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KW - Bladder

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