Bladder reconstruction with autotransplanted ileum in the dog: better functional results than standard enterocystoplasty.
OBJECTIVE
To compare, in a dog model, the properties of a reconstructed bladder (peristalsis, histological changes and absorption) using an autotransplanted ileal segment with standard enterocystoplasty.


METHODS
Female beagle dogs were divided into two groups. In group 1 (autotransplantation, six dogs), a Heineke-Mikulicz-type pouch was constructed using autotransplanted terminal ileum. The artery and vein of the terminal ileum were anastomosed to the iliac artery and vein, respectively. The pouch was anastomosed to the bladder remnant immediately above the vesical triangle. In group 2 (control, five dogs) the same type of bladder reconstruction using terminal ileum was undertaken but with no vessel anastomosis. Bladder function in these two groups was then compared for peristalsis (by monitoring intravesical pressure), histological changes (by microscopy) and glucose reabsorption (by measuring the amount of glucose remaining in the reconstructed bladder). The mean (range) follow-up was 11 (7-18) months for group 1 and 9.2 (7-12) months for group 2; the recovery time before examination was 4.6 (2-7) months for group 1 and 4.0 (2-6) months for group 2.


RESULTS
In group 1, there were no major complications in five dogs after the procedure and they survived for > 7 months; the autotransplant became necrotic in one dog where the arterial diameter was < 1 mm. In the control group, all five dogs survived for > or = 7 months after surgery. Intestinal peristalsis was inhibited in group 1 but not in group 2. The bladder was oval/spherical in group 1 and elongated in group 2, with a thinner epithelium and fewer goblet cells in the latter. Glucose reabsorption was greater in group 2 than in group 1.


CONCLUSIONS
Bladder reconstruction using autotransplanted terminal ileum in dogs is technically feasible. For bowel peristalsis and reabsorption of glucose, autotransplanted ileum may have functional advantages over a standard enterocystoplasty.
Ueno
K
K
Department of Urology, Kobe University School of Medicine, Kobe, Japan.
Yamanaka
N
N
Kimura
K
K
Arakawa
S
S
Kamidono
S
S
Hara
I
I
D000042:Absorption; D000818:Animals; D004285:Dogs; D005260:Female; D005947:Glucose / Q000493:pharmacokinetics; D006801:Humans; D007082:Ileum / Q000033:anatomy & histology / Q000637:transplantation*; D007408:Intestinal Absorption / Q000502:physiology; D010528:Peristalsis / Q000502:physiology; D014182:Transplantation, Autologous; D001743:Urinary Bladder / Q000033:anatomy & histology / Q000601:surgery*
D005947:Glucose