Pathology Laboratory for Translational Medicine, West Virginia University School of Medicine, Morgantown, West Virginia.
American Preclinical Services, Minneapolis, Minnesota.
Neurourol Urodyn. 2018 Sep;37(7):2097-2105. doi: 10.1002/nau.23560. Epub 2018 Mar 31.
We evaluated a Selective Bladder Denervation (SBD) device, which uses radiofrequency ablation, for the treatment of overactive bladder syndrome in terms of its nerve denervation, ablation characteristics, and post-treatment healing.
Using the SBD device, eight fresh extirpated ovine bladder trigones were treated (90°C set point for 60 s) and nitroblue tetrazolium viability stained to characterize the ablation. In addition, 12 trigones were treated in vivo with three adjacent ablations and divided into survival cohorts: Day 7, Day 30, and Day 90 to assess the ablations and their associated healing.
The ex vivo single trigone ablations had a 7.9 ± 0.9 mm width and 5.7 ± 1.0 mm thickness that involved the submucosa, detrusor muscle, adventitia, and vagina. Microscopic viability staining confirmed complete nerve necrosis within the targeted tissue. The in vivo Day 7 trigones supported the ex vivo ablation characteristics and showed up to minimal inflammation, granulation tissue, and collagen fibrosis. Day 30 trigones had essentially absent inflammation and granulation tissue with evolving collagen fibrosis at the ablation's periphery. Day 90 trigones had essentially absent acute inflammation, minimal chronic inflammation, essentially absent granulation tissue, and up to mild collagen fibrosis. No ureteral/urethral alterations, vesico-vaginal fistulas, or other complications were identified.
The SBD device provided a targeted trigone ablation with resultant denervation. The tissue healing timeline followed that expected for a hyperthermic ablation and was characterized by a fibroproliferative healing response with limited inflammation and granulation tissue. The ablations did not impact the overlying bladder mucosal surface.
我们评估了一种选择性膀胱去神经支配（SBD）设备，该设备使用射频消融术治疗膀胱过度活动症，评估其神经去神经支配、消融特性和治疗后愈合情况。
使用 SBD 设备对 8 个新鲜切除的羊膀胱三角区进行处理（设定 90°C 治疗点 60s），并用硝基四唑蓝活力染色来对消融情况进行特征分析。此外，12 个三角区进行了体内治疗，有三个相邻的消融区，并分为存活队列：第 7 天、第 30 天和第 90 天，以评估消融区及其相关的愈合情况。
离体单三角区消融的宽度为 7.9±0.9mm，厚度为 5.7±1.0mm，涉及黏膜下层、逼尿肌、外膜和阴道。显微镜下的活力染色证实了目标组织内的完全神经坏死。体内第 7 天的三角区支持离体消融特征，表现出最小的炎症、肉芽组织和胶原纤维形成。第 30 天的三角区几乎没有炎症和肉芽组织，在消融边缘有进展性胶原纤维形成。第 90 天的三角区几乎没有急性炎症，慢性炎症轻微，几乎没有肉芽组织，胶原纤维形成轻度。没有发现输尿管/尿道改变、膀胱阴道瘘或其他并发症。
SBD 设备提供了一种靶向三角区消融，导致去神经支配。组织愈合时间与预期的热消融相符，其特征是纤维化增生性愈合反应，炎症和肉芽组织有限。消融区未影响覆盖的膀胱黏膜表面。
