Manzoni C, Grottesi A, D'Urzo C, Pintus C, Fadda G, Perrelli L
Division of Pediatric Surgery, Catholic University of the Sacred Heart Medical School, Rome, Italy.
J Surg Res. 2001 Aug;99(2):169-74. doi: 10.1006/jsre.2001.6098.
Bladder autoaugmentation uses partial detrusorectomy to create a diverticular bulge in the bladder mucosa. This technique has eliminated certain serious complications of cystoplasty with gastrointestinal tissues (e.g., fluid/electrolyte/acid-base imbalances, mucous hypersecretion), but the exposed mucosa is subject to fibrosis and, sometimes, to perforation, which can annul the benefits of surgery.
We have developed an original technique based on traditional autoaugmentation with protection of the herniated mucosa by split-thickness pedunculated rectus abdominis muscle flaps that are sutured to the incised margins of the detrusor. Preliminary testing was done on 30 adult Wistar rats. A control group of 15 rats underwent laparotomy alone. Bladder capacity was measured via suprapubic cystography before and after (4 weeks, 8 weeks, 1 year) surgery, just before sacrifice. Sections of the reconstructed bladder were examined histologically.
Twenty-three bladder-augmented rats and 13 controls survived. In the experimental group, bladder capacity increased by 38% (mean). None of the rats experienced urinary retention, although one developed bladder stones. Histology revealed no pathologic changes (other than chronic inflammatory infiltrates at suture sites) in the mucosa, detrusor, or muscle flaps, which were all viable and well integrated by the fourth postoperative week. There were no signs of mucosal or muscle fibrosis.
Preliminary results in a rat model suggest that this new technique can produce an enlarged bladder that is fully functional and less vulnerable to fibrotic retraction and rupture. Residual contractility in the muscle flaps might theoretically be exploited to facilitate paraphysiologic micturition.
膀胱自体扩大术采用部分逼尿肌切除术在膀胱黏膜上形成憩室样膨出。该技术消除了使用胃肠道组织进行膀胱扩大术的某些严重并发症（如液体/电解质/酸碱平衡紊乱、黏液分泌过多），但暴露的黏膜易发生纤维化，有时还会穿孔，这可能会抵消手术的益处。
我们基于传统的自体扩大术开发了一种原创技术，通过带蒂的中厚腹直肌肌瓣保护疝出的黏膜，将其缝合到逼尿肌的切口边缘。对30只成年Wistar大鼠进行了初步测试。15只大鼠的对照组仅接受剖腹手术。在手术前以及手术后（4周、8周、1年）、处死前，通过耻骨上膀胱造影测量膀胱容量。对重建膀胱的切片进行组织学检查。
23只膀胱扩大的大鼠和13只对照大鼠存活。在实验组中，膀胱容量平均增加了38%。没有大鼠出现尿潴留，尽管有一只出现了膀胱结石。组织学检查显示，黏膜、逼尿肌或肌瓣均无病理变化（缝合部位的慢性炎性浸润除外），到术后第四周，它们均存活且整合良好。没有黏膜或肌肉纤维化的迹象。
大鼠模型的初步结果表明，这项新技术可使膀胱扩大且功能完全正常，不易发生纤维化回缩和破裂。理论上，肌瓣中的残余收缩力可用于促进类生理性排尿。
