title: Bladder augmentation with small intestinal submucosa leads to unsatisfactory long-term results.
abstract: OBJECTIVE
  To evaluate the use of small intestinal submucosa (SIS) for bladder augmentation in a series of select patients.
  
  
  METHODS
  Six patients (age 6.5-15.4, mean 9.8 years) underwent bladder augmentation with SIS: one after a cloacal exstrophy repair, one after multiple surgery of the bladder because of vesicoureteral reflux, two with spina bifida, two after bladder exstrophy repair. All suffered from a microbladder with a mean volume of 61.5 ml (range 15-120, 7-36% of expected bladder capacity for age). Preoperative bladder compliance ranged from 1.0 to 3.3 (mean 1.3) ml/cmH2O.
  
  
  RESULTS
  Follow-up time ranged from 4.6 to 33.5 (mean 24.4) months. An increase of bladder volume was achieved in four patients (53-370 ml, 16-95% of expected bladder capacity for age). Bladder compliance postoperatively ranged from 0.9 to 5.6 (mean 3.0) ml/cmH2O. Histological examinations showed a complete conversion of SIS, leaving irregular urothelial lining and bladder wall containing muscular, vascular and relatively thick connective tissue in four patients and regular urothelium in two patients. Major complications were bladder stones in two patients and a bladder rupture in one patient.
  
  
  CONCLUSIONS
  Bladder augmentation with SIS in humans failed to fulfill the hopes raised by animal studies. Due to the insufficient increase in bladder compliance and therefore failure to accomplish sufficient protection of the upper urinary tract, bladder augmentation with SIS cannot be recommended as a substitute for enterocystoplasty.
authors: Department of Pediatric Surgery and Urology, Cnopf'sche Kinderklinik, St.-Johannis-Mühlgasse 19, 90419 Nuremberg, Germany. Electronic address: mattias.schaefer@email.de.
authors: M
authors: M
authors: Schaefer
authors: A
authors: A
authors: Kaiser
authors: M
authors: M
authors: Stehr
authors: H J
authors: HJ
authors: Beyer
mesh_terms: D000293:Adolescent; D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002988:Cloaca / Q000002:abnormalities; D003187:Compliance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D017211:Treatment Failure; D001743:Urinary Bladder / Q000002:abnormalities / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000601:surgery*
keywords: Bladder augmentation; Bladder exstrophy; Cloacal malformation; Enterocystoplasty; Microbladder; Small intestinal submucosa; Urinary bladder; Vesico-ureteral reflux