Laparoscopic laser-assisted bladder autoaugmentation.
OBJECTIVE
The purpose of this study is to examine the feasibility of performing a laparoscopic bladder autoaugmentation and to assess the urodynamic characteristics of an autoaugmented bladder.


METHODS
Laparoscopic bladder autoaugmentation was performed in 9 female canines (20 to 30 kg). Following laparoscopic access to the peritoneal cavity, a midline bladder seromyotomy was performed using the potassium titanyl phosphate 532 nm laser. This produced a large bladder diverticulum. Changes in bladder volume and compliance were quantified over a 3-month period of follow-up.


RESULTS
Urodynamic evaluation demonstrated an increase in bladder capacity 6 weeks postoperatively in 8 of 9 dogs, with an average volume increase of 45%. Bladder compliance improved in 7 of 9 dogs with an average increase in compliance of 67%. Three months postoperatively, bladder capacity remained increased in 5 of 9 dogs, with an average increase in volume of only 5.3%. An improvement in compliance was sustained in 5 of 9 animals with an average increase of 13.9%. Laparoscopic exploration revealed grossly normal bladders with adhesions of omentum to the seromyotomy site in all canines and the anterior abdominal wall in 2 of 9 canines. Histologically, the seromyotomy site was devoid of muscle with an intact urothelium and a proliferation of loose connective tissue.


CONCLUSIONS
The technique of laparoscopic bladder autoaugmentation can be performed easily in the canine model. Although results at 6 weeks show significant improvement, the longer term, 3-month results were not statistically significant. This technique has the potential to offer a minimally invasive correction for patients with low-capacity, high-pressure bladders that have failed pharmacologic treatment.
Britanisky
R G
RG
James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center, NY 10021, USA.
Poppas
D P
DP
Shichman
S N
SN
Mininberg
D T
DT
Sosa
R E
RE
D000009:Abdominal Muscles / Q000473:pathology; D000818:Animals; D003094:Collagen / Q000032:analysis; D003187:Compliance; D003238:Connective Tissue / Q000473:pathology; D004285:Dogs; D005240:Feasibility Studies; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D009852:Omentum / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology; D000267:Tissue Adhesions / Q000473:pathology; D001743:Urinary Bladder / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D014546:Urinary Catheterization; D014563:Urodynamics / Q000502:physiology
D003094:Collagen