Seromuscular Grafts for Bladder Reconstruction: Extra-luminal Demucosalisation of the Bowel

Ramnath Subramaniam,Alexander M Turner,S Khawar Abbas,David F.M Thomas,Jennifer Southgate

doi:10.1016/j.urology.2012.07.047

Ramnath Subramaniam, Alexander M Turner + Show 3 more

Open Access

https://doi.org/10.1016/j.urology.2012.07.047

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Abstract

ObjectiveTo develop a robust sterile, fully demucosalized and vascularized seromuscular patch for use as an adjunct to novel bioengineering techniques aimed at augmenting, reconstructing, or replacing the bladder because of endstage disease. To eliminate deep colonic epithelial crypts to prevent the possibility of colonocyte regrowth. To maintain sterility by excluding the possibility of contamination from the bowel contents.MethodsPilot studies were performed on euthanized pigs to optimize the technique, with tissue samples examined by immunohistochemistry. In vivo, vascularized seromuscular colonic flaps were created from the bowel exterior in 7 large white hybrid pigs. The dissection was facilitated by placing an inflated Foley catheter within the colonic lumen. The seromuscular ends were approximated with 5/0 Vicryl sutures and excess mucosa intussuscepted within the lumen. Demucosalized flaps were used to augment the bladder by composite cystoplasty and were examined immunohistochemically at 3 months.ResultsPilot studies showed that the technique was successful in creating seromuscular segments with no epithelial remnants. When applied surgically, the seromuscular flaps survived and showed no evidence of colonocyte regrowth at 3 months.ConclusionExtraluminal dissection creates robust seromuscular flaps and prevents both regrowth by colonic epithelial cells and contamination of the tissue by exposure to the bowel contents. This technique should find application in a range of bladder reconstruction techniques, including composite cystoplasty and autoaugmentation.

Highlights

Financial Disclosure: The authors declare that they have no relevant financial interests
Other problems include fibrosis and contraction of the seromuscular flap resulting in failure to achieve an adequate bladder capacity after seromuscular colocystoplasty.[6,7,8]
The approach generates adequate urothelium for use in a composite cystoplasty approach, where a demucosalized segment of the colon is combined with autologous urothelial cell sheets grown in the laboratory.[8,15]

Summary

Introduction

Financial Disclosure: The authors declare that they have no relevant financial interests. The standard technique for demucosalization of the colon is to isolate a segment of the bowel and strip the mucosa from within the lumen.[6,7,8] one of the significant problems with this technique is colonic epithelial regrowth with its attendant complications of mucus production.[6,7,8] Other problems include fibrosis and contraction of the seromuscular flap resulting in failure to achieve an adequate bladder capacity after seromuscular colocystoplasty.[6,7,8] Lima et al[9] described the technique of extraluminal demucosalization and termed it “non secretory colocysto- After recovery (4-6 weeks), the pigs underwent seromuscular colocystoplasty, which was patched with the in vitro-generated autologous urothelium and augmented onto the bladder using a Vicryl mesh as a carrier material (detailed elsewhere[15]).

Results

Conclusion