Experimental Study on Ileocystoplasty: 1. A New Technique of Ileocystoplasty: Two Layer Open-flap Method

Kim, Kee See; Lee, H S

Abstract

The treatment of bladder contraction remains as one of the most difficult problems in urological field today despite numerous attempts to overcome this difficulty. Many etiologic factors can be elicited as for the cause of such contractions; more common and important ones being interstitial cystitis, tuberculous infection, various chemical and radiation damages etc. Extensive subtotal bladder resection may also result in limited fluid capacity. All of these can produce severe urinary symptoms of frequency and incontinence and further bilateral renal damages. Until recently the prevalent treatment for the disease complex caused by contracted bladder was diversion of urine either to large bowel or skin, or the use of an indwelling urethral catheter. eliminating the bladder as a reservoir. Although these techniques were proven to be valuable for a certain extent there have been many undesirable aspects. Among the undesirable aspects of diversion of urine are 1. recurrent chronic pyelonephritis caused by organisms from the skin or feces. 2, hydronephrosis from stricture of anastomotic sites, and 3. electrolyte imbalance following transplantation of ureter to bowel. The use of an isolated intestinal segment to segment bladder capacity merits s serious consideration, and the technique of ileocystoplasty may be a possible solution to these difficultise. Results of recent reports on clinical and experimental application of this technique are promising though their methods vary greatly. In the majority a closed tube was anastomosed to the bladder in varying positions but some applied the ileum as an open sheet. The latter method was applied by some in the belief that on open patch of ileum would empty itself more efficiently than a closed type since closed type of ileocystoplasty frequently retained urine. However, control of bleeding during preparation of ileal open sheet have been a major difficulty for application of an open-sheet technique. The purpose of this investigation was to develop a new technique for augmentation of bladder capacity in physiologic manner with diminution of bleeding during the procedure.
MATERIALS AND METHODS
Healthy eight Korean dogs weighing from 15 to 18kg were used. Female dogs were exclusively utilized for the convenience of urinary drainage and catheterization postoperatively. pregnant dogs were not used. In each dog, the bladder was mobilized and then subtotally resected leaving one third of the normal bladder. The level of excision was just above the trigone sothat the ureteral orifices were undisturbed. A 20cm segment of ileum approximately 20cm, from the ileocecal valve was isolated with an intact pedicle of mesentery. The continuity of the bowel was restored by end-to-end anastomosis. The isolated ileum was folded at the middle portion with two clamps each placed on half of isolated segment in length for control of bleeding when incision was made on stitch type and then a cap type of ileal bladder with two layers was sutured to the bladder stump by a mucosa-to-mucosa technique forming a bladder composed principally by ileum. The peritoneal cavity was closed without drainage.In the immediate postoperative period urinary drainage was maintained by urethral catheter.
RESULTS
AND SUMMARY: l. Eight dogs were subjected to ileocystoplasty by the use of two layer ileal open flap. One of them expired because of an accident and seven others survived without incident. 2. The use of the clamps on ileal segment was reliable in controlling bleeding for wider incision to make open ileal flap. 3. Ratio of augmentation of bladder capacity by this technique was twice of that by closed loop technique. 4. The fluid capacity of reconstructed bladder of this technique approached to the tidal capacity 5. One patient with contraction of bladder due to tuberculosis has been satisfactorily palliated by this technique.