Can a pressure-limited vesico-amniotic shunt tube preserve normal bladder function?
BACKGROUND
We have previously shown that a vesico-amniotic shunt (V-A shunt) produces fibrotic bladders with poor compliance in normal fetal lambs. We hypothesized that using a ventriculo-peritoneal shunt (V-P shunt) as a V-A shunt in normal bladders may preserve the filling/emptying cycle and normal bladder development.


METHODS
The V-A shunting in normal fetal lambs was performed at 74 days of gestation using a V-P shunt (group A) and a free-draining shunt tube (group B). Sham-operated lambs were used as controls (group C). They were all delivered at term (145 days), and the pressure-volume curve, bladder volume, and histologic features of the bladder wall were compared.


RESULTS
The mean bladder volume in group B (n = 5), 5 +/- 2.4 mL, was significantly smaller (P < .01) than that in group A (n = 6), 53 +/- 14 mL, and group C (n = 10), 57.3 +/- 12 mL. The bladder wall thickness in group A was 338 + 94.2 microm; group B, 741 +/- 128 microm; and group C, 374 +/- 120 microm. Group B bladders had very poor compliance with thick bladder wall (P < .01). Histologically, group B bladders showed prominent submucosal fibrotic change, but group A bladders were similar to controls.


CONCLUSIONS
This study shows that a pressure-limited shunt tube for V-A shunting preserves the normal fetal bladder development.
Aoba
Takeshi
T
Division of Pediatric Surgery, St Marianna University School of Medicine, Kawasaki 216-8511, Japan.
Kitagawa
Hiroaki
H
Pringle
Kevin C
KC
Koike
Junki
J
Nagae
Hideki
H
Zuccollo
Jane
J
Shimada
Jin
J
Seki
Yasuji
Y
D000199:Actins / Q000032:analysis; D000653:Amniotic Fluid; D000818:Animals; D001724:Birth Weight; D003187:Compliance; D018568:Crown-Rump Length; D005260:Female; D005315:Fetal Diseases / Q000601:surgery*; D046128:Fetal Therapies; D020883:Hysterotomy; D020007:Implants, Experimental; D007668:Kidney / Q000196:embryology; D009929:Organ Size; D011247:Pregnancy; D011312:Pressure; D012756:Sheep / Q000196:embryology; D014524:Urethral Obstruction / Q000196:embryology / Q000601:surgery*; D001743:Urinary Bladder / Q000737:chemistry / Q000196:embryology / Q000502:physiology / Q000601:surgery* / Q000648:ultrastructure; D017287:Ventriculoperitoneal Shunt / Q000295:instrumentation
D000199:Actins