title: Mucosectomy impairs ileal microcirculation and results in flap contraction after experimental ileocystoplasty.
abstract: BACKGROUND
  Bladder augmentation with demucosalized ileal flap is a promising alternative approach for mucus free bladder augmentation; however, the contraction of the flap is still a major concern. It has been hypothesized that mucosectomy causes ischemic damage, but no direct histological evidence has been found and attention is now focused on the urothelium cover to prevent the exposure of the denuded surface to urine or the use of balloons to keep the flaps distended.
  
  
  OBJECTIVE
  Our aim was to study the effect of mucosectomy on the microcirculation of ileal flaps during reverse clam ileocystoplasty using direct intraoperative imaging of the ileum. Since the omentum is successfully used to revascularize ischemic tissue, we also examined whether omentopexy can prevent contraction.
  
  
  METHODS
  Clam ileocystoplasty was performed in anesthetized minipigs with seromuscular (n = 3), seromusculo-submucosal (n = 3) reverse demucosalized ileal flaps. The velocity of the circulating red blood cells (RBCV) and the perfusion rate (PR) was measured with intravital videomicroscopy (Cytoscan A/R, Cytometrics, Philadelphia, PA, USA) before and after mucosectomy and the denuded surface of the ileum was covered with omentum after the reverse augmentation was complete (Figure). Animals were sacrificed after 8 weeks and the ileal flap dimensions were measured.
  
  
  RESULTS
  Significant reduction in RBCV and PR was detected after mucosectomy in both groups; however, no sign of acute flap necrosis or bladder perforation was seen. The omentum was found firmly attached to the ileal flaps, but contraction of the flaps was significant in both groups.
  
  
  CONCLUSIONS
  The disturbance in the microcirculation observed after mucosectomy may be responsible for flap contraction in ileocystoplasty with demucosalized ileum. Omentopexy did not help to prevent contraction.
  
  
  CONCLUSIONS
  Contraction of demucosalized intestinal flaps used for bladder augmentation has been frequently reported. This study provides direct evidence the first time for severely compromised microcirculation of the ileal flaps after mucosectomy. Limitation of the study is the relative low number of animals sacrificed.
authors.affiliation: Department of Paediatric Urology, Royal Manchester Children's Hospital, UK; Institute of Surgical Research, School of Medicine, University of Szeged, Hungary.
authors.forename: Raimondo M
authors.initials: RM
authors.lastname: Cervellione
authors.affiliation: Institute of Surgical Research, School of Medicine, University of Szeged, Hungary.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hajnal
authors.affiliation: Institute of Surgical Research, School of Medicine, University of Szeged, Hungary.
authors.forename: Gabreilla
authors.initials: G
authors.lastname: Varga
authors.affiliation: Department of Paediatric Surgery, Royal Manchester Children's Hospital, UK.
authors.forename: George
authors.initials: G
authors.lastname: Rakoczy
authors.affiliation: Institute of Surgical Research, School of Medicine, University of Szeged, Hungary.
authors.forename: Jozsef
authors.initials: J
authors.lastname: Kaszaki
authors.affiliation: Department of Paediatric Urology, Royal Manchester Children's Hospital, UK.
authors.forename: David
authors.initials: D
authors.lastname: Keene
authors.affiliation: Department of Paediatric Urology, Royal Manchester Children's Hospital, UK.
authors.forename: Anju
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Department of Paediatric Urology, Royal Manchester Children's Hospital, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Dickson
authors.affiliation: Department of Paediatric Urology, Royal Manchester Children's Hospital, UK; Institute of Surgical Research, School of Medicine, University of Szeged, Hungary. Electronic address: tcserni@yahoo.com.
authors.forename: Tamas
authors.initials: T
authors.lastname: Cserni
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D003559:Cystostomy / Q000009:adverse effects* / Q000379:methods; D004195:Disease Models, Animal; D005260:Female; D006084:Graft Rejection; D007082:Ileum / Q000098:blood supply* / Q000637:transplantation; D008833:Microcirculation / Q000502:physiology; D009092:Mucous Membrane / Q000601:surgery; D011897:Random Allocation; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D013552:Swine; D013556:Swine, Miniature; D001743:Urinary Bladder / Q000601:surgery*
keywords: Ileocystoplasty; In vivo microscopy; Microcirculation; Mucosectomy