In situ reversed ileocystoplasty for less invasive augmentation cystoplasty: an experimental study

To evaluate the application of a reversed intact ileal patch for augmentation cystoplasty in terms of improvements in bladder urodynamics and to eliminate the need for bowel anastomosis in an experimental model.

12 cross-bred adult dogs were used for reversed seromuscular ileocystoplasty with intact bowel segment. The procedure was comprised of selecting a 7- to 10-cm ileal loop from about 20 cm proximal to the ileocecal valve. The seromuscular layer of the ileal loop from its antimesenteric aspect was sutured to the bladder mucosa of the previously bivalved bladder with running stitches.

10 animals survived and completed their 4-week follow-up period. Postoperative urodynamic study revealed a 26% increase of mean maximal cystometric capacity [from 226 to 285 ml (p = 0.002)] and a significant increase in mean bladder compliance [from 11.8 to 17.8 ml/cm H(2)O (p = 0.002)]. Mean maximal detrusor filling pressure decreased significantly from 20 to 16.1 cm H(2)O (p = 0.011). Histopathologic examination of the augmented bladder showed complete epithelialization of the serosal surface of ileum with layers of transitional urothelium.

The early results of this less invasive technique were promising in terms of improvements in bladder urodynamic variables and growth of transitional urothelium. Longer follow-up is necessary to show the durability of these effects.