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KMID : 0365819830230010055
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Journal of Pusan Medical College
1983 Volume.23 No. 1 p.55 ~ p.69
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An Experimental Study on Bladder Augmentation Using Gastric Antrum
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Abstract
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Although the features that constitute an ideal cystcplasty are well known, no perfect bladdersubstitiute has yet been found. The grafts from a segment of ileum, sigmoid color or cecum have been most popular, which have some drawbacks respectively. The gastric antrum was an ideal graft for bladder augmentation because of its good blood supply, relatively poor absorbing mucosa, acidification of urine, good contractability and safe procedure.
Gastrocystoplasty was experimentally performed to 15 mongrel dogs, and the operative results, complications, changes of electrolytes, radiographic findings, urine pH as well as histologic and microangiographic findings of the augmented bladder were observed.
The results were as follows:
1. It was able to obtain the results of experimental operations in seven dogs, of which 3 dogs underwent gastrocystopiasty with unilateral ureteror_eoantrosto ny after partial cystectomy and 4 dogs, gastrocystoplasty with bilateral ureteroneoantrostomy after total cystectomy. In the other 8 dogs, however, it was unable to obtain the results because of death due to various reasons such as anesthetic fault, bleeding, panperitonitis, obstruction at gastroduodenal junction and gangrenes of gastric antrum, etc.
2. There were no significant changes in BUN, serum creatinine and electrolytes postoperatively as compared to preoperative data.
3. The retrograde cystographic findings of the dogs undergone partial cystectoty were similar to preoperative ones and those of dogs undergone total cystectomy revealed nearly normal configuration except some depression at the anastomotic site.
4. Postoperative bladder capacity and intravesical pressure showed nonspecific changes in the dogs which had partial cystectomy as compared to the preoperative data. But on the ones which had total cystectomy, the postoperative bladder capacity after 5 months was about one half of the preoperative capacity, but postoperative intravesical pressure showed no significant change as compared to the preoperative pressure.
5. The urinary pH after operation was slightly decreased to be mildly acid as compared to the preoperative one.
6. There was no gross evidence of ulceration in the in situ stomach and the grastrocystoplastic bladder but microscopically the anastomotic sites showed moderate inflammatory reactions which gradually subsided and gastric foveolae revealed some atrophy.
7. The vascular patterns on the microangiographic findings of augmented gastrocystoplastic bladder, showed that the left gastroepiploic artery was only the one supplying sufficiently to the gastric antrum. Revascularization in the anstomotic site of the gastric antrum to the bladder in 3 to 4 months was accomplished.
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