von Heyden B, Anthony J P, Kaula N, Brock G B, Jakse G, Tanagho E A
Department of Urology, University of California School of Medicine, San Francisco.
J Urol. 1994 Apr;151(4):1081-7. doi: 10.1016/s0022-5347(17)35188-1.
The treatment of choice for bladder atonia is clean intermittent catheterization. To eliminate the catheter-related morbidity and increase the quality of life for patients with an atonic bladder, the restoration of bladder contractility would be desirable. Based on our hypothesis that skeletal muscle might augment bladder contractility, we designed the present study to examine the ability of the latissimus dorsi muscle in situ to empty a bladder-like reservoir and to regenerate after division and repair of the supplying motor nerve. In 4 dogs, the left latissimus dorsi muscle was dissected, mobilized and wrapped around a bladder substitute (100-ml. silicone reservoir). Stimulation of the thoracodorsal nerve resulted in the evacuation of 63.8 +/- 6.2% of the reservoir's volume and a maximum pressure of 109.5 +/- 18.6 cm. H2O. Four months later, the thoracodorsal nerve supplying motor control to the muscle was transected and microsurgically reanastomosed. Using transcutaneous stimulation, we recorded the pressure generation and resulting evacuation at regular intervals for 8 months (that is, 12 months after the initial surgery). At the end of this period, the pressure was 79.3 +/- 12.1 cm. H2O (72.4% of the initial value), expelling 48.3 +/- 6.7% of total volume. This long-term study demonstrates: (1) the ability of the transposed latissimus dorsi muscle to evacuate a bladder-like reservoir; and (2) the regenerative potential of muscle and nerve after nerve transsection and repair. Use of skeletal muscle, which can be readily stimulated, may serve to facilitate bladder emptying and provide a treatment alternative to intermittent catheterization in the future.
膀胱无张力的首选治疗方法是清洁间歇性导尿。为了消除与导尿管相关的发病率并提高无张力膀胱患者的生活质量，恢复膀胱收缩力将是理想的。基于我们的假设，即骨骼肌可能增强膀胱收缩力，我们设计了本研究，以检查背阔肌在原位排空膀胱样储液器的能力以及在供应运动神经切断和修复后再生的能力。在4只狗中，解剖、游离左侧背阔肌并将其包裹在膀胱替代物（100毫升硅胶储液器）周围。刺激胸背神经导致储液器63.8±6.2%的容量被排空，最大压力为109.5±18.6厘米水柱。四个月后，切断并显微外科重新吻合支配该肌肉运动的胸背神经。使用经皮刺激，我们在8个月（即初次手术后12个月）内定期记录压力产生和由此导致的排空情况。在此期间结束时，压力为79.3±12.1厘米水柱（初始值的72.4%），排出总体积的48.3±6.7%。这项长期研究表明：（1）移位的背阔肌排空膀胱样储液器的能力；（2）神经切断和修复后肌肉和神经的再生潜力。使用易于刺激的骨骼肌可能有助于促进膀胱排空，并在未来为间歇性导尿提供一种替代治疗方法。
