Autoaugmentation gastrocystoplasty: early clinical results

Abstract

This new technique seems to have a place in the management of the neuropathic bladder, but further laboratory study and cautious clinical application is required to ascertain its role in bladder augmentation.

Urothelial Lined Colocystoplasty in a Sheep Model

“…This is in contrast to the improved results when autoaugmentation is added to other demucosalised enterocystoplasty models. Mau [20] combined au toaugmentation and demucosalised small bowel entero cystoplasty in the pig with moderate success, and similar ly encouraging results have been reported with autoaug mentation gastrocystoplasty in sheep [9,26] and children [11].…”

“…Many of these studies have recorded the problem of overgrowth of ileal and/or colonic mucosa, a problem which Blandy suggested was solved by removal of the submucosa [25], as for our ani mals when diathermy dissection was used. The same tech nique, when applied to the sheep stomach [9], and the stomach and colon of the human [11,23] produced a satisfactory muscle patch, indicating that it is the delicate colonic muscle rather than the diathermy technique that is responsible for the poor outcome in the AACC animals. The stripping of the colonic mucosa with subsequent regrowth is obviously not acceptable for human proce dures.…”

“…The sheep colonic muscle tolerated the demucosalisation procedure poorly, reflected in an inflamed, haemorrhagic colonic seg ment in the animals sacrificed within 1 month; this may have been the reason for the poor results, and explain why the autoaugmentation did not improve the outcome. Colonic mucosal regrowth occurred in 5, and was related to the demucosalisation technique.has been noted to cause transient gastrointestinal tract problems [11,12], leading us to explore the use of autoaugmentation colocystoplasty (AACC), comparing the results with a demucosalised clam colocystoplasty (DMCC) group in which the colon was covered by ingrowth from the adjacent urothelium.The colon demucosalisation proved difficult using dia thermy dissection, and the muscle segment tolerated the removal of its mucosa less satisfactorily than sheep stom ach. The animals included later in the study therefore had the colonic mucosa removed by stripping with forceps.…”

Autoaugmentation gastrocystoplasty: further studies of the sheep model

“…Experimental success with autoaugmentation colocystoplasty and autoaugmentation gastrocystoplasty (AAGC) led to the clinical use of these methods in children in the last decade [9][10][11][12][13][14]. However, in several clinical series AAGC has failed to produce a reliable augmentation effect [15][16][17]. Many factors have been implicated in the failures, including patient selection, surgical technique and postoperative management.…”

“…This problem was identified in the sheep model of autoaugmentation colocystoplasty when the dissection plane was made between the bowel mucosa and bowel muscularis. In AAGC the correct dissection plane through the gastric submucosa is easier to achieve, although extreme care must be taken during the demucosalization process to avoid cautery injury to the gastric muscle [16].…”