title: Restoring voluntary urinary voiding using a latissimus dorsi muscle free flap for bladder reconstruction.
abstract: We present our data using innervated latissimus dorsi muscle (LDM) free flaps to assist acontractile bladder function. Twelve dogs were used. In group I (n = 3), the LDM flaps were elevated and wrapped around silicon reservoirs; in group II (n = 4), the LDM flaps were transferred into the pelvis and used to reconstruct bladders that had 50% of their detrusor muscle wall removed; group III (n = 5) was the same setup as group II but the bladder mucosa was also removed with 50% detrusor wall. The LDM flaps were electrically stimulated and electromyography, cystography, urodynamic, and hydrodynamic measurements were performed. In clinical studies, LDM flaps were used in 11 patients (age range, 9-68 years). Our animal studies demonstrated that LDM flaps are capable of generating pressures (190 cm H(2)O at 15 mL and 35 cm H(2)O at a 10 mL in group I at 6 months) to void the bladder. In group II, contractions were present after 9 months. Eight of 11 patients who underwent LDM free flap were able to void voluntarily and without catheterization. LDM flap activity was confirmed using ultrasonography/tomography. Our clinical studies indicated that contractile function can be restored using LDM free flaps.
authors.affiliation: Department of Urology, University of Innsbruck Medical Center, Anichstrasse 35, A-6020 Innsbruck, Austria. arnulf.stenzl@uibk.ac.at
authors.forename: A
authors.initials: A
authors.lastname: Stenzl
authors.forename: M
authors.initials: M
authors.lastname: Ninkovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002648:Child; D004195:Disease Models, Animal; D004285:Dogs; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000637:transplantation*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D013524:Surgical Flaps; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014555:Urination Disorders / Q000601:surgery*; D014563:Urodynamics