Caione Paolo, Boldrini Renata, Salerno Annamaria, Nappo Simona Gerocarni
Division of Pediatric Urology, Department of Nephrology-Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy.
Pediatr Surg Int. 2012 Apr;28(4):421-8. doi: 10.1007/s00383-012-3063-0. Epub 2012 Feb 19.
A preliminary experience on in vivo bladder wall regeneration in a subset of patients born with exstrophy-epispadias complex is reported. The objective was to improve bladder capacity and compliance without bowel augmentation.
Five patients (3 males, 2 females), mean age 10.4 years, presenting poor bladder capacity and compliance after complete exstrophy repair, underwent bladder augmentation using small intestinal submucosa (SIS) scaffold. Ultrasonography, cystoscopy with cystogram, assessment of bladder volume and compliance and bladder biopsy were performed before surgery (T0), at 6 (T1) and 18 months (T2) follow-up. Histology was compared with normal bladder specimens. Wilcoxon test was adopted for statistics.
Bladder capacity and compliance resulted increased (+30%) at T1 (p < 0.05) and remained stable at T2, despite dry intervals did not changed significantly. Bladder biopsy at T1 showed no evidence of SIS, but normal transitional mucosa and sero-muscular layer containing smooth muscle fascicles, small nerve trunks and vessels within abundant type-3 collagen. Muscle/collagen ratio was decreased compared with controls at T1 and T2 (p < 0.05). No kidney damage, bladder diverticula, or stones were observed at 3 years follow-up.
Bladder regeneration was feasible in these patients, but bladder capacity and compliance was poorly increased to obtain significant clinical benefit. Histology showed poor muscle components. The acellular matrix grafting failed to provide long-term effective results in terms of continence achievement.
报告对一部分患有膀胱外翻-尿道上裂复合畸形的患者进行体内膀胱壁再生的初步经验。目的是在不进行肠道扩大术的情况下提高膀胱容量和顺应性。
5例患者（3例男性，2例女性），平均年龄10.4岁，在完全膀胱外翻修复后膀胱容量和顺应性较差，接受了使用小肠黏膜下层（SIS）支架的膀胱扩大术。在手术前（T0）、随访6个月（T1）和18个月（T2）时进行超声检查、膀胱造影膀胱镜检查、膀胱容量和顺应性评估以及膀胱活检。将组织学与正常膀胱标本进行比较。采用Wilcoxon检验进行统计学分析。
尽管无尿间隔时间无明显变化，但在T1时膀胱容量和顺应性增加（+30%）（p<0.05），在T2时保持稳定。T1时的膀胱活检未发现SIS的证据，但有正常的移行黏膜和包含平滑肌束、小神经干和血管的浆膜肌层，其中有丰富的Ⅲ型胶原。在T1和T2时，与对照组相比，肌肉/胶原比率降低（p<0.05）。在3年的随访中未观察到肾脏损害、膀胱憩室或结石。
在这些患者中膀胱再生是可行的，但膀胱容量和顺应性增加不佳，无法获得显著的临床益处。组织学显示肌肉成分较差。就实现控尿而言，脱细胞基质移植未能提供长期有效的结果。
