CLINICAL STUDIES ON CYSTOPLASTY

A Study on Cystoplasty by Regeneration of Contracted Bladder Using Novectane (Liquid Synthetic Resin)-sprayed Thin Paper (2)

Abstract

Our cystoplasty regenerates and expands the bladder as performed and reported in a case report by the authors in “A Study on Cystoplasty by Regeneration of Contracted Bladder using Novectane (Liquid Synthetic Resin)-sprayed Thin Paper (1)”.
This first case has been under postoperative clinical observation for more than two years and a half. The fact that the bladder capacity has increased from 50-60cc before the operation to 400cc and the residual urine is less than 10cc indicates long-lasting very favorable results of cystoplasty. Even 2 years after the cystoplasty it was not possible to discriminate the regenerated bladder wall from the original bladder wall under the cystoscopic examination. Both urine analysis and cystogram indicate a normal state.
Case 1 has becomes the basis for further cystoplasty being performed by the author, H. Taguchi. Two additional clinical cases with more complicated conditions than Case 1 are reported below.
Preoperative condition and Surgical Method:
Case 2 is a 24 year old female. About 10 years ago she underwent nephrectomy of the right kidney because of kidney tuberculosis. Her main complaint was two-stage urination and micturition accompanied by a continuous sensation of residual urine. The PSP test by insertion of the Nelaton catheter gave a 15 minute value of 30% and a 2 hour value of 75%. Fig. 1 (1), (2) indicates the retrograde cystograms prior to the operation.
Fig. 1. (1) shows bladder form after infusion of 60 cc contrast media.
Fig. 1. (2) shows bladder form after infusion of about 200cc at maximum desire to urinate.
Almost all cystograms indicated the same bladder shadows. Vesico-ureteral reflux was recognized reaching as far as the renal pelvis. Hydronephrosis was evident and the ureter was enlarged. The bladder capacity was less than 20cc.
According to the pathological conditions of the subjects two different operations were applied. One operation (A) was performed to prevent vesico-ureteral reflux and consisted of triangular flap method, 2) according to which ureter was anastomosed to the original bladder. The other, operation (B), was aimed to increase the capacity of the bladder content and composed of cystoplasty, which was performed in the same method as in Case 1 by using an artificial bladder prepared from Novectanesprayed thin paper.
Case 3 is a 50 year-old female. About 3 years ago she underwent nephrectomy of the right kidney because of kidney tuberculosis. And about 2 years ago she underwent nephrostomy of the left kidney because of a stricture in the lower end of the left ureter. Therefore, for more than a year, the bladder had not been used.
Fig. 3 shows a pyelogram (pyelo-ureterogram), in which contrast media was injected from nephrostomy, and a retrograde cystogi am taken before operation. The lower end of the ureter is completely closed ey a stricture. The cystogram was taken at maximum desire to urinate and the bladder capacity was about 50cc. This patient visited our hospital because of urgent desire to urina te from the normal urethra. However, the PSP test revealed an unfavorable condition as with a 15 minute value of 5-10% and 2 hour value of 30-40%. Cystoplasty was performed in Case 3 by the same method as (A) and (B) of Case 2.
The operation time was less than 2 hours in all three cases. The operation was performed under spinal anesthesia in Case 1, which was comparatively simple, and in Case 3 with lowered kidney function. The operation in Case 2 was performed under general anesthesia by tracheal insertion.
In addition, bladder inflammation of these 3 cases were remedied before operation.
Post-operative Observations:
As in Case 1, in both Cases 2 and 3, the artificial bladder, in an utterly unchanged state, fell off completely within the bladder in about 3 weeks, concurrent with the completion of the granulation wall of the regenerated bladder1). It was possible to completely extirpate the