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Autoaugmentation gastrocystoplasty: further studies of the sheep model
Clare E Close1, Paul D Anderson, Glenn A Edwards
1University of Nevada School of Medicine, Department of Surgery and Pediatrics, Las Vegas, Nevada, USA. cclose@surgery.bsd.uchicago.edu
Objective:
To report our experience with autoaugmentation gastrocystoplasty (AAGC, reported to result in an inconsistent augmentation effect in children) in a sheep model, specifically addressing issues of surgical techniques and postoperative bladder drainage that may affect the augmentation result, as many factors have been implicated in the poor outcome.
Materials And Methods:
Ten 6-month-old male lambs had a suprapubic catheter placed by an open laparotomy. Intraoperative urodynamics were evaluated before and after detrusorotomy for autoaugmentation and after completing AAGC. The bladder was drained with no distension for 1 week after surgery and the urodynamic evaluation repeated on control and experimental animals 6 months after surgery. The animals were then killed and the bladders evaluated for gastric flap survival and histological changes in the native bladder and augmentation segments. The results were analysed using a one-sided Student's t-test.
Results:
The median (range) native bladder volume at leak-point pressure was 110 (40-490) mL. Intraoperative bladder volumes after completing AAGC confirmed adequate augmentation segments in all animals. The urodynamic evaluation at 6 months after AAGC showed increases in bladder volumes in nine of 10 animals (0-1336 mL), significantly greater than the increase in volume in the control sheep (median 337.5 vs 115.3 mL; P < 0.05). The bladder compliance (volume/pressure at leak capacity) 6 months after AAGC was slightly better but not significantly higher than in controls (median 17.3 vs 10.8 mL/cmH(2)O; P > 0.05). The median (range) ratio of surviving gastric flap to native bladder circumferences was 34.5 (31-53)%. Histology showed scarring of the submucosal layer in one of 10 augmentation segments and normal urothelium in all bladders.
Conclusion:
AAGC produces reliable bladder augmentation and excellent bladder compliance in a sheep model of a non-neurogenic bladder. The gastric flap survived well and there was no bladder wall separation with simple postoperative catheter drainage.
