title: Tissue engineered cystoplasty augmentation for treatment of neurogenic bladder using small intestinal submucosa: an exploratory study.
abstract: OBJECTIVE
  Bladder augmentation with enterocystoplasty is the gold standard therapy for neurogenic bladder. The presence of gastrointestinal segments in the urinary tract has been associated with many complications. We investigated an alternative approach using small intestinal submucosa as scaffold for reconstruction.
  
  
  METHODS
  We selected 8 candidates with poor bladder capacity and compliance for small intestinal submucosa cystoplasty. Candidate age ranged from 14 to 54 years, and included 6 patients with myelomeningoceles and 2 patients with spinal cord injuries. Serial urodynamics, cystograms, ultrasonography and serum analyses were used to assess the outcomes of surgery.
  
  
  RESULTS
  Followup range was 11 to 36 months (mean 12). Compared to the preoperative findings there were significant increases in maximum bladder capacity (p<0.05) at the 3 and 12-month followup (170.1±75.7 ml preoperatively, 365.6±68.71 ml at 3 months and 385.5±52.8 ml at 12 months), an increase in bladder compliance (p<0.01) at the 12-month followup (5.9±4.0 ml/cm H2O preoperatively and 36.3±30.0 ml/cm H2O at 12 months) and a decrease in maximum detrusor pressure (p<0.05) at the 12-month followup (43.6±35.7 cm H2O preoperatively and 15.1±7.6 cm H2O at 12 months). Bowel function returned promptly after surgery. No metabolic consequences were noted and no urinary calculi were observed. Renal function was preserved.
  
  
  CONCLUSIONS
  Small intestinal submucosa can be used as a scaffold for rebuilding a functional bladder. Tissue engineering technology provides a potentially viable option for genitourinary reconstruction in patients with neurogenic bladder.
authors.affiliation: Department of Urology, China Rehabilitation Research Center, Rehabilitation College of Capital Medical University, Beijing, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Urology, China Rehabilitation Research Center, Rehabilitation College of Capital Medical University, Beijing, China. Electronic address: lmliao@263.net.
authors.forename: Limin
authors.initials: L
authors.lastname: Liao
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D023822:Tissue Engineering; D001743:Urinary Bladder / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D013520:Urologic Surgical Procedures; D055815:Young Adult
keywords: intestine; neurogenic; small; tissue engineering; urinary bladder