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Electrically stimulated detrusor myoplasty.
J G Van Savage1, G P Perez-Abadia, L G Palanca
1Divisions of Pediatric Urology, and Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
The Journal of Urology
|August 25, 2000
Summary
Rectus detrusor myoplasty uses electrical stimulation of a rectus abdominis muscle flap to improve bladder contractility and emptying in a canine model. This technique shows promise for children with neurogenic bladder.
Area of Science:
- Urology
- Biomedical Engineering
- Surgical Innovation
Background:
- Children with spina bifida often require clean intermittent catheterization for bladder emptying.
- Existing methods like direct nerve stimulation have limited success.
- Neurogenic bladder leads to hyporeflexic or areflexic bladder states.
Purpose of the Study:
- To investigate the feasibility of rectus detrusor myoplasty for achieving bladder contractility.
- To evaluate electrical stimulation of a rectus abdominis muscle flap wrapped around the bladder.
- To assess the potential for enhanced bladder emptying in patients with poor detrusor contractility.
Main Methods:
- Rectus detrusor myoplasty was performed on 8 cadavers to assess feasibility.
- A unilateral rectus abdominis muscle flap was wrapped around the bladder, preserving key neurovascular structures.
- The flap was electrically stimulated in 8 dogs at varying frequencies (40, 60, 80 Hz) to measure intravesical pressure and post-void residual.
Main Results:
- Electrical stimulation significantly increased intravesical pressure over baseline (p <0.05).
- Increased intravesical pressure ranged from 35 +/- 5 cm H2O to 45 +/- 7 cm H2O with stimulation.
- Post-void residual decreased, showing reasonable bladder emptying at tested frequencies.
Conclusions:
- Electrically stimulated detrusor myoplasty effectively increases intravesical pressure and promotes bladder emptying in an animal model.
- This technique shows potential for treating children with poor detrusor contractility and neurogenic bladder.
- Further chronic studies are underway to validate detrusor myoplasty for clinical application.