Sigmoid cystoplasty with argon beam without mucosa

Area of Science:

• Urology
• Surgical Innovation
• Regenerative Medicine

Background:

• Intestinal bladder augmentation is prone to complications like mucus production and metabolic issues.
• Excluding intestinal mucosa from the urinary tract can prevent these adverse events.
• Argon beam treatment offers a novel approach to mucosal ablation in augmentation cystoplasty.

Purpose of the Study:

• To evaluate the clinical, urodynamic, ultrasound, and pathological outcomes of sigmoid cystoplasty without mucosa, utilizing argon beam treatment.
• To assess the efficacy and safety of this modified technique in patients with neurogenic bladder.
• To determine if argon beam application impacts the integrity of deeper intestinal layers.

Main Methods:

• Sigmoid cystoplasty without mucosa was performed on 10 patients (ages 3-14) with neurogenic bladder.
• Argon beam was used to ablate the mucosa before its removal.
• Patients were followed for a mean of 18 months, with assessments including ultrasound, urodynamics, and biopsies.

Main Results:

• All 10 patients achieved dryness with intermittent catheterization every >4 hours, with no clinical urinary tract infections.
• Bladder capacity significantly increased (80ml to 300ml), and compliance improved (mean 15 ml/cm H2O).
• Intraoperative and postoperative biopsies showed damaged mucosa but intact submucosal and deeper layers, with connective tissue metaplasia.

Conclusions:

• Sigmoid cystoplasty without mucosa, enhanced by argon beam, is a technically straightforward procedure.
• The technique demonstrates satisfactory clinical and urodynamic results for bladder augmentation.
• Argon beam application effectively prevents postoperative bleeding and residual glandular tissue, contributing to favorable outcomes.