V13-01 A PRE-CLINICAL MODEL OF URODYNAMICS

Abstract

You have accessJournal of UrologyFemale Pelvic Surgery (V13)1 Apr 2020V13-01 A PRE-CLINICAL MODEL OF URODYNAMICS Samuel Weprin*, Dielle Meyer, Natalie Swavely, Naveen Nandanan, John T. Roseman, and Adam Klausner Samuel Weprin*Samuel Weprin* More articles by this author , Dielle MeyerDielle Meyer More articles by this author , Natalie SwavelyNatalie Swavely More articles by this author , Naveen NandananNaveen Nandanan More articles by this author , John T. RosemanJohn T. Roseman More articles by this author , and Adam KlausnerAdam Klausner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000970.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multi-channel urodynamics is the primary tool for evaluation of storage and voiding dysfunction of the lower urinary tract. However, it is invasive and prone to artifact, which can make interpretation difficult and leads to questions of its clinical utility and ability to guide treatment. A pre-clinical model of urodynamics will advance understanding of the lower urinary tract system’s storage and voiding functions and allow for the development of more accurate diagnostic tests and more effective clinical treatments. The “Grover” ex vivo porcine model allows for a pre-clinical testing environment that simulates human bladder function. METHODS: The first phase of the porcine model is to harvest the lower urinary tract. After identification of the relevant genitourinary anatomy, proximal and distal control of the small bowel is obtained to prevent spillage of bowel contents. This is followed by entering the retroperitoneum by incising directly over the kidney and freeing up adhesions to expose the kidneys bilaterally. Attention is then turned towards the bladder and the rectum where the lateral attachments, which keep the bladder and the rectum in place, are dissected free after obtaining proximal and distal control at the level of the rectum with suture ligation. The genitourinary system can then be removed en bloc by dissecting bluntly along the retroperitoneal space, keeping the major vessels anterior and the connective tissue attachments on the posterior aspect of the dissection. Preparation of the bladder involves heparinizing the arterial tree, followed by removal of the gastrointestinal and gynecological structures and suture ligation of the ureters. The bladder can then be placed into a physiologic buffer prior to construction of the porcine model. RESULTS: The porcine models were transported to the laboratory within two hours and experiments were conducted within 48 hours. Polyethylene cannulas are placed through the aorta into the bilateral iliac arteries and advanced into the bilateral superior vesical arteries, which are then secured in place with 2-0 silk ties. The model is then fully set up in a heated and humidified chamber to replicate physiologic conditions. The result is a fully functional and physiologic bladder model that allows for evaluation of the effects of ischemic insult, retention, and many other clinical scenarios. CONCLUSIONS: An ex vivo porcine model creates a pre-clinical testing environment where the etiology of various types of bladder dysfunction can be better elucidated. This model also allows for the testing of new clinical interventions in a safe environment prior to initiating clinical trials in a human model. Source of Funding: This study was supported by National Institutes of Health award R01DK101719. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1211-e1211 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Weprin* More articles by this author Dielle Meyer More articles by this author Natalie Swavely More articles by this author Naveen Nandanan More articles by this author John T. Roseman More articles by this author Adam Klausner More articles by this author Expand All Advertisement PDF downloadLoading ...