Britanisky R G, Poppas D P, Shichman S N, Mininberg D T, Sosa R E
James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center, NY 10021, USA.
Urology. 1995 Jul;46(1):31-5. doi: 10.1016/S0090-4295(99)80154-X.
The purpose of this study is to examine the feasibility of performing a laparoscopic bladder autoaugmentation and to assess the urodynamic characteristics of an autoaugmented bladder.
Laparoscopic bladder autoaugmentation was performed in 9 female canines (20 to 30 kg). Following laparoscopic access to the peritoneal cavity, a midline bladder seromyotomy was performed using the potassium titanyl phosphate 532 nm laser. This produced a large bladder diverticulum. Changes in bladder volume and compliance were quantified over a 3-month period of follow-up.
Urodynamic evaluation demonstrated an increase in bladder capacity 6 weeks postoperatively in 8 of 9 dogs, with an average volume increase of 45%. Bladder compliance improved in 7 of 9 dogs with an average increase in compliance of 67%. Three months postoperatively, bladder capacity remained increased in 5 of 9 dogs, with an average increase in volume of only 5.3%. An improvement in compliance was sustained in 5 of 9 animals with an average increase of 13.9%. Laparoscopic exploration revealed grossly normal bladders with adhesions of omentum to the seromyotomy site in all canines and the anterior abdominal wall in 2 of 9 canines. Histologically, the seromyotomy site was devoid of muscle with an intact urothelium and a proliferation of loose connective tissue.
The technique of laparoscopic bladder autoaugmentation can be performed easily in the canine model. Although results at 6 weeks show significant improvement, the longer term, 3-month results were not statistically significant. This technique has the potential to offer a minimally invasive correction for patients with low-capacity, high-pressure bladders that have failed pharmacologic treatment.
本研究旨在探讨进行腹腔镜膀胱自体扩大术的可行性，并评估自体扩大膀胱的尿动力学特征。
对9只体重20至30千克的雌性犬进行腹腔镜膀胱自体扩大术。通过腹腔镜进入腹腔后，使用532纳米磷酸钛氧钾激光进行膀胱中线浆肌层切开术。这形成了一个大的膀胱憩室。在3个月的随访期内对膀胱容量和顺应性的变化进行量化。
尿动力学评估显示，9只犬中有8只在术后6周膀胱容量增加，平均容量增加45%。9只犬中有7只膀胱顺应性改善，平均顺应性增加67%。术后3个月，9只犬中有5只膀胱容量仍增加，平均容量仅增加5.3%。9只动物中有5只顺应性持续改善，平均增加13.9%。腹腔镜探查显示，所有犬的膀胱大体正常，网膜与浆肌层切开部位粘连，9只犬中有2只与前腹壁粘连。组织学检查显示，浆肌层切开部位无肌肉，尿路上皮完整，疏松结缔组织增生。
腹腔镜膀胱自体扩大术在犬模型中可轻松实施。虽然6周时的结果显示有显著改善，但3个月的长期结果无统计学意义。该技术有可能为药物治疗无效的低容量、高压膀胱患者提供微创矫正方法。
